Provider Demographics
NPI:1194541201
Name:KYMBERLY MAESTAS, LPC, LLC
Entity type:Organization
Organization Name:KYMBERLY MAESTAS, LPC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESTAS-CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CAS, NCC
Authorized Official - Phone:970-623-0512
Mailing Address - Street 1:300 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2404
Mailing Address - Country:US
Mailing Address - Phone:970-549-2849
Mailing Address - Fax:970-549-1400
Practice Address - Street 1:300 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2404
Practice Address - Country:US
Practice Address - Phone:970-549-2849
Practice Address - Fax:970-549-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-23
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty