Provider Demographics
NPI:1063702447
Name:KIMENOUR, JAMES JOSEPH (LPC)
Entity type:Individual
Prefix:PROF
First Name:JAMES
Middle Name:JOSEPH
Last Name:KIMENOUR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 BURHOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2410
Mailing Address - Country:US
Mailing Address - Phone:215-620-3956
Mailing Address - Fax:
Practice Address - Street 1:7615 BURHOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2410
Practice Address - Country:US
Practice Address - Phone:215-620-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005604101YP2500X
PC005604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional