Provider Demographics
NPI:1144478116
Name:KIMBERLY K. HYATT PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:KIMBERLY K. HYATT PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:937-938-7242
Mailing Address - Street 1:500 LINCOLN PARK BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3492
Mailing Address - Country:US
Mailing Address - Phone:937-938-7242
Mailing Address - Fax:937-938-7355
Practice Address - Street 1:500 LINCOLN PARK BLVD STE 108
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-3492
Practice Address - Country:US
Practice Address - Phone:937-938-7242
Practice Address - Fax:937-938-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004145101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty