Provider Demographics
NPI:1881948537
Name:HENINGER, KIMBERLY A (LCPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HENINGER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-0160
Mailing Address - Country:US
Mailing Address - Phone:406-370-8877
Mailing Address - Fax:406-458-8113
Practice Address - Street 1:366 W SPRUCE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4108
Practice Address - Country:US
Practice Address - Phone:406-370-8837
Practice Address - Fax:406-458-8113
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT72614101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH6076Medicaid
AKTEZ175Medicare PIN