Provider Demographics
NPI:1770286585
Name:POHL, KIMBERLEY (LAC)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:POHL
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 E ENCANTO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5952
Mailing Address - Country:US
Mailing Address - Phone:480-942-9410
Mailing Address - Fax:
Practice Address - Street 1:13260 N 94TH DR STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4242
Practice Address - Country:US
Practice Address - Phone:623-487-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor