Provider Demographics
NPI:1174964209
Name:EVANS, KIMBERLY C (LMFT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:C
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 SOMERSET BLVD UNIT 1903
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-8795
Mailing Address - Country:US
Mailing Address - Phone:213-509-0887
Mailing Address - Fax:
Practice Address - Street 1:848 W LANCASTER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2347
Practice Address - Country:US
Practice Address - Phone:310-647-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68921106H00000X
CA97370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist