Provider Demographics
NPI:1376607796
Name:JONES, KIMBERLY ISSAC (LMHC, RPH)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ISSAC
Last Name:JONES
Suffix:
Gender:F
Credentials:LMHC, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5492 SE NASSAU TER
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-2438
Mailing Address - Country:US
Mailing Address - Phone:561-262-8456
Mailing Address - Fax:
Practice Address - Street 1:125 W INDIANTOWN RD STE 106
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3539
Practice Address - Country:US
Practice Address - Phone:561-371-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH26173101YM0800X
FLPS34635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No183500000XPharmacy Service ProvidersPharmacist