Provider Demographics
NPI:1528471489
Name:WILLIAMS, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WILLIAMS
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 1:9140 W POST RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2435
Mailing Address - Country:US
Mailing Address - Phone:702-405-2210
Mailing Address - Fax:
Practice Address - Street 1:3005 W HORIZON RIDGE PKWY
Practice Address - Street 2:STE 300
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5029
Practice Address - Country:US
Practice Address - Phone:702-251-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6647-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6647-SOtherLICENSE