Provider Demographics
NPI:1447621511
Name:RILEY, KIMBERLY (LMFT)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 EASTHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2305
Mailing Address - Country:US
Mailing Address - Phone:360-440-4021
Mailing Address - Fax:
Practice Address - Street 1:532 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1403
Practice Address - Country:US
Practice Address - Phone:360-440-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61000202106H00000X
ORT2564106H00000X
CA143217106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty