Provider Demographics
NPI:1285387175
Name:CORNETT, KIMBERLY ALLISON (MS, NCC, LCDC, LPCA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALLISON
Last Name:CORNETT
Suffix:
Gender:F
Credentials:MS, NCC, LCDC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 AIRLINE RD APT E8
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4604
Mailing Address - Country:US
Mailing Address - Phone:361-429-6564
Mailing Address - Fax:
Practice Address - Street 1:1925 GRAND AVE STE 129
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2776
Practice Address - Country:US
Practice Address - Phone:406-346-3146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional