Provider Demographics
NPI:1902156938
Name:AYERS, KIMBALL CUTLER (LMFTA)
Entity Type:Individual
Prefix:
First Name:KIMBALL
Middle Name:CUTLER
Last Name:AYERS
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 NE 9TH PLACE NE
Mailing Address - Street 2:UNIT 1007
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-753-9608
Mailing Address - Fax:425-454-0411
Practice Address - Street 1:10610 NE 9TH PL
Practice Address - Street 2:UNIT 1007
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4378
Practice Address - Country:US
Practice Address - Phone:425-753-9608
Practice Address - Fax:425-454-0411
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG 60261540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMG 60261540OtherMARRIAGE AND FAMILY THERAPIST ASSOCIATE LICENSE