Provider Demographics
NPI:1518020833
Name:HYATT, KIMBERLY KAE (MSED PCC CCDCI)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:KAE
Last Name:HYATT
Suffix:
Gender:F
Credentials:MSED PCC CCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004145101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor