Healthcare Provider Details

I. General information

NPI: 1548601370
Provider Name (Legal Business Name): BILLIE JO KIMMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 HIGHWAY 12 E STE 2
WILLMAR MN
56201-5811
US

IV. Provider business mailing address

2320 HIGHWAY 12 E STE 2
WILLMAR MN
56201-5811
US

V. Phone/Fax

Practice location:
  • Phone: 320-214-9692
  • Fax:
Mailing address:
  • Phone: 320-214-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2585
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2585
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: