Provider Demographics
NPI:1780714105
Name:KIM, HANNA (LMFT)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-3234
Mailing Address - Country:US
Mailing Address - Phone:760-255-5700
Mailing Address - Fax:760-256-5092
Practice Address - Street 1:18818 HWY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-9234
Practice Address - Country:US
Practice Address - Phone:760-995-8813
Practice Address - Fax:760-995-8929
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF57809106H00000X
CA85175106H00000X
CALMFT85175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist