Provider Demographics
NPI:1174345474
Name:SOUTIEN, KIMBERLY J (LMHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:SOUTIEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9741 SW 152ND ST
Mailing Address - Street 2:413C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:786-379-9602
Mailing Address - Fax:
Practice Address - Street 1:12360 SW 132ND CT STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6461
Practice Address - Country:US
Practice Address - Phone:305-588-4143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health