Provider Demographics
NPI:1356065312
Name:KIMM, ABIGAIL J (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:J
Last Name:KIMM
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:KIMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP
Mailing Address - Street 1:3021 UPLAND DR UNIT 6
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5871
Mailing Address - Country:US
Mailing Address - Phone:970-658-9182
Mailing Address - Fax:
Practice Address - Street 1:3021 UPLAND DR UNIT 6
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5871
Practice Address - Country:US
Practice Address - Phone:970-658-9182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005888103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling