Provider Demographics
NPI:1932684206
Name:CAVALLO, KIMBERLY GINETTE (LMFT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:GINETTE
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3849
Mailing Address - Country:US
Mailing Address - Phone:503-410-3149
Mailing Address - Fax:
Practice Address - Street 1:955 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3849
Practice Address - Country:US
Practice Address - Phone:503-410-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2033106H00000X
WALF60918392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist