Healthcare Provider Details

I. General information

NPI: 1235597832
Provider Name (Legal Business Name): KRISTY NIMZ MANCC/LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY NIMZ MA/LPC/NCC

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WALNUT TRL
BUSHKILL PA
18324-8774
US

IV. Provider business mailing address

2115 WALNUT TRL
BUSHKILL PA
18324-8774
US

V. Phone/Fax

Practice location:
  • Phone: 908-763-3540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00537100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: