Provider Demographics
NPI:1720139629
Name:MCDANIEL, KIM D (LMHC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:D
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:D
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:22348 NE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4146
Mailing Address - Country:US
Mailing Address - Phone:425-898-7368
Mailing Address - Fax:
Practice Address - Street 1:10827 NE 68TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4000
Practice Address - Country:US
Practice Address - Phone:425-889-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health