Provider Demographics
NPI:1962438606
Name:KIMPER, TERRENCE P (PHD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:P
Last Name:KIMPER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 TAMIAMI TRL N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2700
Mailing Address - Country:US
Mailing Address - Phone:239-398-0009
Mailing Address - Fax:
Practice Address - Street 1:3060 TAMIAMI TRL N
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2700
Practice Address - Country:US
Practice Address - Phone:239-398-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI05-0468084OtherUNITED HEALTH PLANS
RI413074OtherCOORDINATED HEALTH PLANS
RI29801-02OtherBLUE CROSS & BLUE SHIELD
RI413074OtherCOORDINATED HEALTH PLANS