Provider Demographics
NPI:1861563546
Name:CHARRON, KIMBERLY ANNE (RN, LMHP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:CHARRON
Suffix:
Gender:F
Credentials:RN, LMHP
Other - Prefix:
Other - First Name:CROSSROADS
Other - Middle Name:COUNSELING
Other - Last Name:SERVICES, P.C.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MS
Mailing Address - Street 1:PO BOX 5855
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5855
Mailing Address - Country:US
Mailing Address - Phone:308-384-7119
Mailing Address - Fax:
Practice Address - Street 1:2121 N WEBB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-384-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1466101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025452000Medicaid
NE4765OtherMIDLANDS CHOICE PROVIDER
NE84717OtherBCBS PROVIDER NUMBER