Provider Demographics
NPI:1336619790
Name:KIM, JEONG HAN (PHD, CRC)
Entity Type:Individual
Prefix:DR
First Name:JEONG HAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST STOP 6225
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-6225
Mailing Address - Country:US
Mailing Address - Phone:806-743-2135
Mailing Address - Fax:806-743-3244
Practice Address - Street 1:3601 4TH ST STOP 6225
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-6225
Practice Address - Country:US
Practice Address - Phone:806-743-2135
Practice Address - Fax:806-743-3244
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor