Doctor Name: | KIM NOVAK |
NPI Number: | 1013077957 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LPC, NCC |
License Number: | 5810 |
Business Practice Address: | 6600 Firestone Blvd Firestone, CO - 805046605 |
Business Phone Number: | 3035796975 |
Business Fax Number: | |
Mailing Address: | Po Box 314, FIRESTONE |
State: | CO |
Postal Code: | 805200314 |
Phone Number: | 3035796975 |
Fax Number: | |
NPI Enumeration Date: | 12/11/2006 |
NPI Last Update Date: | 09/30/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5810 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |