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General NPI Number Information
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NPI Number | 1396406211
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Entity Type | Individual
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Provider Name | KARISSA KIMES LAMFT
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Gender | Female
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1042 W MILL AVE STE 103
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2489
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Country | US
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Telephone | 208-699-3667
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 N LAKEWOOD DR STE 225
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2473
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Country | US
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Telephone | 208-699-3667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LAMFT-7786
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License Number State | ID
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