Provider Demographics
NPI:1952559403
Name:KIMMERLY, LORI (LMFT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KIMMERLY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33507 9TH AVE S
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6397
Mailing Address - Country:US
Mailing Address - Phone:253-347-2579
Mailing Address - Fax:253-288-2320
Practice Address - Street 1:33507 9TH AVE S
Practice Address - Street 2:SUITE C-3
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6397
Practice Address - Country:US
Practice Address - Phone:253-347-2579
Practice Address - Fax:253-288-2320
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60172540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist