Healthcare Provider Details

I. General information

NPI: 1790407013
Provider Name (Legal Business Name): KIMBERLY VAHJEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E MISSOURI AVE STE 340
PHOENIX AZ
85014-2753
US

IV. Provider business mailing address

13708 E WINDSTONE TRL
SCOTTSDALE AZ
85262-6632
US

V. Phone/Fax

Practice location:
  • Phone: 602-932-3336
  • Fax:
Mailing address:
  • Phone: 203-417-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MN-749
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24241
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-OH-750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: