Healthcare Provider Details

I. General information

NPI: 1376981423
Provider Name (Legal Business Name): ADAM KIM MS/EDS, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10840 RUSHING FLUME DR
RENO NV
89521-6204
US

IV. Provider business mailing address

10840 RUSHING FLUME DR
RENO NV
89521-6204
US

V. Phone/Fax

Practice location:
  • Phone: 971-303-8776
  • Fax:
Mailing address:
  • Phone: 503-806-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61221488
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP6086-R
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4888
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: