Healthcare Provider Details

I. General information

NPI: 1912348459
Provider Name (Legal Business Name): KIMBERLEE MILLER HANEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58945 BUSINESS CENTER DR SUITE D
YUCCA VALLEY CA
92284-7307
US

IV. Provider business mailing address

73973 TWO MILE RD APT 193
TWENTYNINE PALMS CA
92277-4629
US

V. Phone/Fax

Practice location:
  • Phone: 760-228-9657
  • Fax:
Mailing address:
  • Phone: 818-620-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF75006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: