Provider Demographics
NPI:1902116189
Name:KESSELL, KIM ANN
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:KESSELL
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 1:5610 KITSAP WAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5610 KITSAP WAY
Practice Address - Street 2:SUITE 350
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2292
Practice Address - Country:US
Practice Address - Phone:360-479-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60160462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health