Provider Demographics
NPI:1932241932
Name:HARKINS-SCHUELKE, KIMBERLY RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RENEE
Last Name:HARKINS-SCHUELKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 BURLINGTON AVE
Mailing Address - Street 2:STE 101B
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5666
Mailing Address - Country:US
Mailing Address - Phone:406-549-7177
Mailing Address - Fax:
Practice Address - Street 1:1018 BURLINGTON AVE
Practice Address - Street 2:STE 101B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5666
Practice Address - Country:US
Practice Address - Phone:406-549-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT216103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0493038Medicaid
MT50881OtherBLUE CROSS BLUE SHIELD
MT0493038Medicaid