Healthcare Provider Details

I. General information

NPI: 1235278995
Provider Name (Legal Business Name): KIMBERLEE CHRISTINA ROSA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 E ACOMA DR SUITE A203
SCOTTSDALE AZ
85254-3553
US

IV. Provider business mailing address

7010 E ACOMA DR SUITE A203
SCOTTSDALE AZ
85254-3553
US

V. Phone/Fax

Practice location:
  • Phone: 602-501-0678
  • Fax: 602-494-4454
Mailing address:
  • Phone: 602-501-0678
  • Fax: 602-494-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1785
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: