Provider Demographics
NPI:1356889596
Name:BRASSETT, KIMBERLY (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:BRASSETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23832 ROCKFIELD BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2870
Mailing Address - Country:US
Mailing Address - Phone:949-689-9870
Mailing Address - Fax:
Practice Address - Street 1:23832 ROCKFIELD BLVD STE 120
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2870
Practice Address - Country:US
Practice Address - Phone:949-689-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT106787106H00000X
CAIMF78024106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist