Provider Demographics
NPI:1740568658
Name:BERNT, KIMBERLY B (LCPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:BERNT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:B
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:P O BOX 4571
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205
Mailing Address - Country:US
Mailing Address - Phone:208-243-9308
Mailing Address - Fax:208-544-9574
Practice Address - Street 1:850 E CENTER ST, STE A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6211
Practice Address - Country:US
Practice Address - Phone:208-243-9308
Practice Address - Fax:208-844-9574
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6437101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional