Provider Demographics
NPI:1235493073
Name:MASSALE, KIMBERLY OTTINGER (MA, LCPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:OTTINGER
Last Name:MASSALE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 WELTON ST STE 2001005
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-3300
Mailing Address - Country:US
Mailing Address - Phone:720-222-5033
Mailing Address - Fax:
Practice Address - Street 1:2590 WELTON ST STE 2001005
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-3300
Practice Address - Country:US
Practice Address - Phone:720-222-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4403101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional