Provider Demographics
NPI:1780969113
Name:FISEL, KIMBERLY D (MA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:FISEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 LARAMIE BLVD.
Mailing Address - Street 2:UNIT F
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-918-9114
Mailing Address - Fax:
Practice Address - Street 1:947 LARAMIE BLVD
Practice Address - Street 2:UNIT F
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4737
Practice Address - Country:US
Practice Address - Phone:303-918-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health