Provider Demographics
NPI:1336367572
Name:PETERSON, KIMBERLY KAY (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KAY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST AVE
Mailing Address - Street 2:SUITE 531
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2216
Mailing Address - Country:US
Mailing Address - Phone:206-240-5833
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE
Practice Address - Street 2:SUITE 531
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2216
Practice Address - Country:US
Practice Address - Phone:206-240-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health