Provider Demographics
NPI:1669522165
Name:THOMAS, KIMBERLY JOANN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 LAKE CITY WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7757
Mailing Address - Country:US
Mailing Address - Phone:206-417-9904
Mailing Address - Fax:
Practice Address - Street 1:2719 E MADISON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4752
Practice Address - Country:US
Practice Address - Phone:206-302-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053181101YP2500X
WACG60171011175T00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No175T00000XOther Service ProvidersPeer Specialist