Provider Demographics
NPI:1932223260
Name:HAZOURI-YEARY, KIMBERLY ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:HAZOURI-YEARY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 THE GREENS WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2499
Mailing Address - Country:US
Mailing Address - Phone:904-543-0161
Mailing Address - Fax:904-543-9172
Practice Address - Street 1:1538 THE GREENS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2499
Practice Address - Country:US
Practice Address - Phone:904-543-0161
Practice Address - Fax:904-543-9172
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health