Provider Demographics
NPI:1972289270
Name:STARK, KIMBERLY SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUE
Last Name:STARK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 NW W HWY
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-9117
Mailing Address - Country:US
Mailing Address - Phone:816-308-0246
Mailing Address - Fax:816-566-0486
Practice Address - Street 1:321 W YOUNG AVE STE A
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1111
Practice Address - Country:US
Practice Address - Phone:816-308-0246
Practice Address - Fax:816-566-0486
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140545103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling