Provider Demographics
NPI:1386081669
Name:KIM, JOSELYN (CSW-I)
Entity type:Individual
Prefix:
First Name:JOSELYN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 S EASTERN AVE STE 29
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6100
Mailing Address - Country:US
Mailing Address - Phone:702-401-0811
Mailing Address - Fax:
Practice Address - Street 1:4580 S EASTERN AVE STE 29
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6100
Practice Address - Country:US
Practice Address - Phone:702-401-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-11271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical