Provider Demographics
NPI:1265557805
Name:KLUGER-BELL, KIM (MFT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:KLUGER-BELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2769 IRIS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4405
Mailing Address - Country:US
Mailing Address - Phone:303-517-3702
Mailing Address - Fax:
Practice Address - Street 1:2769 IRIS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4405
Practice Address - Country:US
Practice Address - Phone:303-517-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO860106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO860OtherMARRIAGE AND FAMILY THERAPIST