Provider Demographics
NPI:1043346208
Name:LIMON, KIMEL A (PSYD)
Entity type:Individual
Prefix:DR
First Name:KIMEL
Middle Name:A
Last Name:LIMON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16340 LOWER HARBOR RD
Mailing Address - Street 2:# 331
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-8303
Mailing Address - Country:US
Mailing Address - Phone:541-254-0941
Mailing Address - Fax:707-812-6106
Practice Address - Street 1:550 H ST
Practice Address - Street 2:STE 1N
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3736
Practice Address - Country:US
Practice Address - Phone:541-254-0941
Practice Address - Fax:707-812-6106
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 17613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY176130Medicaid
CACP17613Medicare ID - Type Unspecified