Provider Demographics
NPI:1295900363
Name:DONIHUE, KIMBERLY MICHELLE (MA CLINICAL PSYCHOLO)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:DONIHUE
Suffix:
Gender:F
Credentials:MA CLINICAL PSYCHOLO
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:HAVERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 RITZ CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5825
Mailing Address - Country:US
Mailing Address - Phone:314-295-5166
Mailing Address - Fax:
Practice Address - Street 1:777 S NEW BALLAS RD STE 129W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8745
Practice Address - Country:US
Practice Address - Phone:314-295-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MO2008010204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist