Provider Demographics
NPI:1679781694
Name:KINSEY, KIMBERLY LEAH (LMFT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LEAH
Last Name:KINSEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:LEAH
Other - Last Name:PEDIGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:920 LAKE DR
Mailing Address - Street 2:APARTMENT 5-C
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-3822
Mailing Address - Country:US
Mailing Address - Phone:601-594-6750
Mailing Address - Fax:
Practice Address - Street 1:2627 RIDGEWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4993
Practice Address - Country:US
Practice Address - Phone:601-594-6750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST0286106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist