Provider Demographics
NPI:1427942937
Name:WIMBUSH, KIMBERLY L (MS MA LAC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:WIMBUSH
Suffix:
Gender:F
Credentials:MS MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34462 N RICHARDSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-5431
Mailing Address - Country:US
Mailing Address - Phone:815-516-4135
Mailing Address - Fax:
Practice Address - Street 1:34462 N RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5431
Practice Address - Country:US
Practice Address - Phone:815-516-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health