Provider Demographics
NPI:1447983853
Name:KIMMONS, KAREN ANNE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:KIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W SIERRA MADRE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-1956
Mailing Address - Country:US
Mailing Address - Phone:469-813-7565
Mailing Address - Fax:
Practice Address - Street 1:701 W SIERRA MADRE AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-1956
Practice Address - Country:US
Practice Address - Phone:469-813-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93429101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional