Provider Demographics
NPI:1902616733
Name:FACTOR, KIMBERLY (EDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:FACTOR
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 AL TAHOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4502
Mailing Address - Country:US
Mailing Address - Phone:530-541-2850
Mailing Address - Fax:
Practice Address - Street 1:1021 AL TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-4502
Practice Address - Country:US
Practice Address - Phone:530-541-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool