1487720934 NPI number — MRS. KIMBERLEY ANN COVINGTON LMFT

Table of content: MRS. KIMBERLEY ANN COVINGTON LMFT (NPI 1487720934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487720934 NPI number — MRS. KIMBERLEY ANN COVINGTON LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COVINGTON
Provider First Name:
KIMBERLEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487720934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
852 MANZANITA CT
Provider Second Line Business Mailing Address:
SUITE #140
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95926-2399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-899-1412
Provider Business Mailing Address Fax Number:
530-899-1412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
852 MANZANITA CT
Provider Second Line Business Practice Location Address:
SUITE #140
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-2399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-899-1412
Provider Business Practice Location Address Fax Number:
530-899-1412
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  42220 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42220 . This is a "MARRIAGE&FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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