Provider Demographics
NPI:1730232760
Name:ABERNETHY, KIM A (LPC)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:A
Last Name:ABERNETHY
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 1:7026 BELGOLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-1002
Mailing Address - Country:US
Mailing Address - Phone:281-744-9477
Mailing Address - Fax:281-719-0576
Practice Address - Street 1:7026 BELGOLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-1002
Practice Address - Country:US
Practice Address - Phone:281-744-9477
Practice Address - Fax:281-719-0576
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0289787-02Medicaid