Provider Demographics
NPI:1689845430
Name:NYKANEN, KIMBERLEY V (LMHC, PCC)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:V
Last Name:NYKANEN
Suffix:
Gender:F
Credentials:LMHC, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 SILTON PEACE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3935
Mailing Address - Country:US
Mailing Address - Phone:813-677-6736
Mailing Address - Fax:813-677-6736
Practice Address - Street 1:12311 SILTON PEACE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3935
Practice Address - Country:US
Practice Address - Phone:813-677-6736
Practice Address - Fax:813-677-6736
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9369101YM0800X
OHE0007976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health