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General NPI Number Information
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NPI Number | 1407363690
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Entity Type | Organization
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Legal Business Name | KIMBERLY B RASMUSSEN, PLLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 850 E CENTER ST STE F
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City | POCATELLO
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State | ID
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Zip | 83201-5737
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Country | US
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Telephone | 208-243-9308
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Fax | 208-544-9574
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Provider Business Mailing Address
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Address Line | 850 E CENTER ST STE F
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City | POCATELLO
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State | ID
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Zip | 83201-5737
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Country | US
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Telephone | 208-243-9308
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Fax | 208-544-9574
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY BERNT
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Credential | LCPC
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Telephone | 208-243-9308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-6437
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License Number State | ID
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