Provider Demographics
NPI:1013062983
Name:BESHEER, KIMBROUGH ALLAN (MDIV, LMHC, IAAP)
Entity Type:Individual
Prefix:
First Name:KIMBROUGH
Middle Name:ALLAN
Last Name:BESHEER
Suffix:
Gender:M
Credentials:MDIV, LMHC, IAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14253 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5522
Mailing Address - Country:US
Mailing Address - Phone:425-747-4868
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE STE 632
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2231
Practice Address - Country:US
Practice Address - Phone:206-232-3253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health