Provider Demographics
NPI:1487142790
Name:HUNT, KIMBERLY DAWN (CP60916001)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:HUNT
Suffix:
Gender:F
Credentials:CP60916001
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:NACHES
Mailing Address - State:WA
Mailing Address - Zip Code:98937-0332
Mailing Address - Country:US
Mailing Address - Phone:509-307-6744
Mailing Address - Fax:
Practice Address - Street 1:2609 RIVER RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1133
Practice Address - Country:US
Practice Address - Phone:509-494-8815
Practice Address - Fax:844-215-7281
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60916001101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)