Provider Demographics
NPI:1053563502
Name:BRADY, KIMBERLY D (MS LMHC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:BRADY
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:FECHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 E 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2926
Mailing Address - Country:US
Mailing Address - Phone:509-209-3503
Mailing Address - Fax:509-747-0609
Practice Address - Street 1:1403 S GRAND BLVD STE 101S
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2272
Practice Address - Country:US
Practice Address - Phone:509-209-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60529373101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health