Provider Demographics
NPI:1730506387
Name:KIMBERLY SHURTLEFF HARTMAN, LCSW, A PC
Entity type:Organization
Organization Name:KIMBERLY SHURTLEFF HARTMAN, LCSW, A PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZATION OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SHURTLEFF
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-465-9357
Mailing Address - Street 1:PO BOX 50875
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-0875
Mailing Address - Country:US
Mailing Address - Phone:719-465-9357
Mailing Address - Fax:719-452-3491
Practice Address - Street 1:1414 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7431
Practice Address - Country:US
Practice Address - Phone:719-465-9357
Practice Address - Fax:719-452-3491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9916291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1669450771OtherINDIVIDUAL NPI