Healthcare Provider Details

I. General information

NPI: 1194062695
Provider Name (Legal Business Name): KIMBERLY K HANDWERK MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2386
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2386
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-6880
  • Fax: 231-935-6873
Mailing address:
  • Phone: 231-935-6880
  • Fax: 231-935-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: