Provider Demographics
NPI:1366260895
Name:BEATH, KIMBERLEE DEANA (AMFT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:DEANA
Last Name:BEATH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 ROCKLIN RD APT 416
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3528
Mailing Address - Country:US
Mailing Address - Phone:916-647-7748
Mailing Address - Fax:
Practice Address - Street 1:265 NEVADA ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4617
Practice Address - Country:US
Practice Address - Phone:916-647-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health