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General NPI Number Information
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NPI Number | 1710429121
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Entity Type | Organization
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Legal Business Name | KIMBERLY FERNANDES LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 441 E 4TH ST STE 101
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City | LOVELAND
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State | CO
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Zip | 80537-5653
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Country | US
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Telephone | 970-673-7372
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Fax |
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Provider Business Mailing Address
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Address Line | 838 RANCHHAND DR
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City | BERTHOUD
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State | CO
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Zip | 80513-2679
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Country | US
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Telephone | 970-673-7372
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR, NA
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Name | KIMBERLY FERNANDES
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Credential | LPC, NCC
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Telephone | 970-673-7372
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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 | 0014046
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License Number State | CO
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