| Doctor Name: | KIMBERLEY LOUISE GRUENING MCNICKLE |
| NPI Number: | 1295073039 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | LH00006744 |
| Business Practice Address: | 6512 20th Street Ct W Suite B Fircrest, WA - 984666212 |
| Business Phone Number: | 2535665559 |
| Business Fax Number: | 2535650274 |
| Mailing Address: | 6512 20th Street Ct W, Suite B FIRCREST |
| State: | WA |
| Postal Code: | 984666212 |
| Phone Number: | 2535665559 |
| Fax Number: | 2535650274 |
| NPI Enumeration Date: | 01/29/2013 |
| NPI Last Update Date: | 01/29/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LH00006744 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |