Provider Demographics
NPI:1982896049
Name:DAVIS, KIMBERLY LOUISE (MS, LCMFT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 N BUCKNER ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1824
Mailing Address - Country:US
Mailing Address - Phone:316-209-7316
Mailing Address - Fax:
Practice Address - Street 1:345 RIVERVIEW ST
Practice Address - Street 2:SUITE LL2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4200
Practice Address - Country:US
Practice Address - Phone:316-262-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist