Provider Demographics
NPI:1699956706
Name:BLAND, KIMBERLY GENE (CPC; MFT; QMHP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GENE
Last Name:BLAND
Suffix:
Gender:F
Credentials:CPC; MFT; QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 SPANISH RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1354
Mailing Address - Country:US
Mailing Address - Phone:702-731-0909
Mailing Address - Fax:702-826-4757
Practice Address - Street 1:400 SHADOW LN STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4355
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV394-L101YA0400X
NVCPC 0024101YP2500X
NV01197106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1699956706Medicaid