Provider Demographics
NPI:1174166375
Name:MINSHEW, KIM (CPSS)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MINSHEW
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 WEATHERLY RD SE STE 111
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-1181
Mailing Address - Country:US
Mailing Address - Phone:256-686-9195
Mailing Address - Fax:256-304-5381
Practice Address - Street 1:1428 WEATHERLY RD SE STE 111
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-1181
Practice Address - Country:US
Practice Address - Phone:256-686-9195
Practice Address - Fax:256-304-5381
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCPSS-5-11-15-4405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional