Provider Demographics
NPI:1184048860
Name:FOUCHE, KIMBERLY ANDRE (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANDRE
Last Name:FOUCHE
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 1:1129 MARICOPA HWY # B111
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3126
Mailing Address - Country:US
Mailing Address - Phone:805-889-5998
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 250
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3571
Practice Address - Country:US
Practice Address - Phone:805-769-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT112973101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA112973OtherLMFT LICENSE NUMBER