| Doctor Name: | KIM MICHELLE COLLUCCI |
| NPI Number: | 1144688169 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BFA |
| License Number: | |
| Business Practice Address: | 217 S Toppenish Ave Toppenish, WA - 989481780 |
| Business Phone Number: | 5098655121 |
| Business Fax Number: | 5098652064 |
| Mailing Address: | 217 S Toppenish Ave, Po Box 151 TOPPENISH |
| State: | WA |
| Postal Code: | 989481780 |
| Phone Number: | 5098655121 |
| Fax Number: | 5098652064 |
| NPI Enumeration Date: | 02/04/2016 |
| NPI Last Update Date: | 02/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |