1386142164 NPI number — KIMBERLY CLAPP MARRIAGE AND FAMIY THERAPIST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386142164 NPI number — KIMBERLY CLAPP MARRIAGE AND FAMIY THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBERLY CLAPP MARRIAGE AND FAMIY THERAPIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1386142164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 4TH ST APT 29
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90405-5519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-403-9180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 OCEAN PARK BLVD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MONICA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90405-3270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-403-9180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2018

Additional Information

Authorized Official

Authorized Official Last Name:
CLAPP
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
LMFT
Authorized Official Telephone Number:
310-403-9180

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  47049 , 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)





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