Provider Demographics
NPI:1013009943
Name:CORTS, KIMBERLY (MSSW, LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CORTS
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 CENTENNIAL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1696
Mailing Address - Country:US
Mailing Address - Phone:615-882-4196
Mailing Address - Fax:615-413-9995
Practice Address - Street 1:5300 CENTENNIAL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-1696
Practice Address - Country:US
Practice Address - Phone:615-882-4196
Practice Address - Fax:615-413-9995
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05870104100000X
TN78371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0283507Medicaid
IA0283507Medicaid