Basic Information
| Provider Information | |||||||||
| NPI: | 1760158653 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRINGTON | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1640 ALTA DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024746450 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1640 ALTA DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024746450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CI5023 | NV | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | CI5023 | NV | N | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | CPC-I | 01 | NV | CI5023 | OTHER |