Provider Demographics
NPI:1265596381
Name:PONTIUS, KIMBERLEY (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BILLY SUNDAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8048
Mailing Address - Country:US
Mailing Address - Phone:515-337-1764
Mailing Address - Fax:515-233-2440
Practice Address - Street 1:420 KELLOGG AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6226
Practice Address - Country:US
Practice Address - Phone:515-233-3141
Practice Address - Fax:515-233-2440
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health