Provider Demographics
NPI:1013272210
Name:SURVE, KIMBERLY KAY (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAY
Last Name:SURVE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7039 29TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9737
Mailing Address - Country:US
Mailing Address - Phone:651-288-0332
Mailing Address - Fax:651-288-0493
Practice Address - Street 1:7039 20TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MN
Practice Address - Zip Code:55038-9737
Practice Address - Country:US
Practice Address - Phone:651-288-0332
Practice Address - Fax:651-288-0493
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1825106H00000X
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist