Provider Demographics
NPI:1851584916
Name:ACCURSO, KIMBERLY R (LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:ACCURSO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:R
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-0375
Mailing Address - Country:US
Mailing Address - Phone:307-431-1178
Mailing Address - Fax:
Practice Address - Street 1:735 BIG HORN AVE
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-2605
Practice Address - Country:US
Practice Address - Phone:307-431-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC612101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1770688871Medicaid