Provider Demographics
NPI:1093031361
Name:THREETHS, KIMBERLEE G (MFT)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:G
Last Name:THREETHS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MERIDIAN AVE
Mailing Address - Street 2:STE 207A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-4331
Mailing Address - Country:US
Mailing Address - Phone:408-596-3850
Mailing Address - Fax:
Practice Address - Street 1:1155 MERIDIAN AVE
Practice Address - Street 2:STE 207A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-4331
Practice Address - Country:US
Practice Address - Phone:408-596-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist