Provider Demographics
NPI:1962809020
Name:CANTY, KIMBERLY ANN (MA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:CANTY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2265 LAVA LN
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-3578
Mailing Address - Country:US
Mailing Address - Phone:719-580-5833
Mailing Address - Fax:719-589-5795
Practice Address - Street 1:2265 LAVA LN
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3578
Practice Address - Country:US
Practice Address - Phone:719-580-5833
Practice Address - Fax:719-589-5795
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0104840101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor