Doctor Name: | TEE KIMMONS |
NPI Number: | 1194023416 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 10217 San Pablo Ave El Cerrito, CA - 945303111 |
Business Phone Number: | 5105591594 |
Business Fax Number: | 5105591590 |
Mailing Address: | 10217 San Pablo Ave, EL CERRITO |
State: | CA |
Postal Code: | 945303111 |
Phone Number: | 5105591594 |
Fax Number: | 5105591590 |
NPI Enumeration Date: | 03/10/2011 |
NPI Last Update Date: | 03/10/2011 |
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: |