MEDICARE: MRS. KIMBERLEE GAIL BAZO LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60165744	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12189026	OTHER	WA	CAQH

General Provider Information

NPI Number	:	1427355171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLEE GAIL BAZO LMHC

Provider Business Mailing Address
First Line	:	101 CREEK CROSSING BLVD
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2765
Country	:	US
Telephone Number	:	253-229-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CREEK CROSSING BLVD
Second Line	:
City	:	HAINESPORT
State	:	NJ
Zip	:	08036-2765
Country	:	US
Telephone Number	:	253-229-5535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	07/10/2023

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