Healthcare Provider Details

I. General information

NPI: 1952424475
Provider Name (Legal Business Name): KIMBERLY CUISINOT MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIRCLE
GRASS VALLEY CA
95945
US

IV. Provider business mailing address

500 CROWN POINT CIR SUITE 120
GRASS VALLEY CA
95945-9514
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-1437
  • Fax: 530-271-0257
Mailing address:
  • Phone: 530-265-1437
  • Fax: 530-271-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number26023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: