Provider Demographics
NPI:1861797318
Name:SMEALL, KIMBERLY DAWN (BA)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DAWN
Last Name:SMEALL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:KRIPPAEHNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFTA
Mailing Address - Street 1:3318 BRIDGEPORT WAY W # D3
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4598
Mailing Address - Country:US
Mailing Address - Phone:253-564-4450
Mailing Address - Fax:
Practice Address - Street 1:3318 BRIDGEPORT WAY W # D3
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4598
Practice Address - Country:US
Practice Address - Phone:253-564-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
WAMG60288353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health