Healthcare Provider Details

I. General information

NPI: 1104220516
Provider Name (Legal Business Name): MRS. KIMBERLY PERROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KIMBERLY MCCOY

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 SUTTON RD
CINCINNATI OH
45230-3521
US

IV. Provider business mailing address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-5010
  • Fax: 513-231-8651
Mailing address:
  • Phone: 513-741-3100
  • Fax: 513-741-5686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC.C.1200436
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: