Provider Demographics
NPI:1487367892
Name:HUBBARD, KIMBERLY M (ND)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 CALIFORNIA AVE SW APT 103
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1665
Mailing Address - Country:US
Mailing Address - Phone:310-855-2636
Mailing Address - Fax:
Practice Address - Street 1:5941 CALIFORNIA AVE SW APT 103
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1665
Practice Address - Country:US
Practice Address - Phone:310-855-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13388101YM0800X
175L00000X
CA137664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No175L00000XOther Service ProvidersHomeopath