Provider Demographics
NPI:1992011373
Name:GARRISON, KIMBERLY ELAINE (PSYD,)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELAINE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:PSYD,
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELAINE
Other - Last Name:BERTELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6924 S OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1124
Mailing Address - Country:US
Mailing Address - Phone:720-353-2947
Mailing Address - Fax:
Practice Address - Street 1:6924 S OLIVE WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1124
Practice Address - Country:US
Practice Address - Phone:720-353-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004445103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist