Provider Demographics
NPI:1194971101
Name:FUZZELL, KIM
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:FUZZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5424
Mailing Address - Country:US
Mailing Address - Phone:417-291-1662
Mailing Address - Fax:
Practice Address - Street 1:805 7TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1113
Practice Address - Country:US
Practice Address - Phone:707-445-1195
Practice Address - Fax:707-445-1802
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor