Provider Demographics
NPI:1164785564
Name:TRICKEY, KIMBERLY KAYE (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:KAYE
Last Name:TRICKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2225
Mailing Address - Country:US
Mailing Address - Phone:715-315-0930
Mailing Address - Fax:
Practice Address - Street 1:153 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2225
Practice Address - Country:US
Practice Address - Phone:715-315-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4641-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4641-125OtherLPC LICENSE