DR. MIKE KIM (NPI# 1104160910) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1104160910 |
Entity Type | Individual |
Full Name | DR. MIKE KIM |
Credential | PSY.D. |
Practice Address |
2900 Louisiana Boulevard Northeast Suite C1 Albuquerque NM 87110 |
Practice Telephone | 5058847873 |
Mailing Telephone | 5058847873 |
Enumeration Date | 2012-11-16 |
Last Update Date | 2016-09-14 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 103T00000X | Psychologist | PSY21256 | CA | Behavioral Health & Social Service Providers |
Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
0036 | NM | Behavioral Health & Social Service Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1568022242 | Mike Sunwoo Kim | Student in an Organized Health Care Education/Training Program | 301 Fisher St Rm 1g123, Keesler Afb, MS 39534-2519 | 2019-06-16 |
1134396112 | Mike Tae Seok Kim | Family Medicine | 840 W Irving Park Rd, Ste 201, Chicago, IL 60613-3011 | 2008-05-09 |
1184818973 | Mike Y Kim | Dentist | 14820 Pacific Ave S, Tacoma, WA 98444-4655 | 2007-09-05 |
1386764934 | Mike S. Kim | Pharmacist | 25965 Normandie Ave, Harbor City, CA 90710-3416 | 2007-03-29 |
1215968706 | Mike Kim | Chiropractor | 3511 W Olympic Blvd, 202, Los Angeles, CA 90019-3563 | 2006-07-05 |
Street Address |
2900 LOUISIANA BOULEVARD NORTHEAST SUITE C1 |
City | ALBUQUERQUE |
State | NM |
Zip Code | 87110 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932533361 | Abq Psychiatric Services, LLC | Community/Behavioral Health | 2900 Louisiana Boulevard Northeast, Suite C1, Albuquerque, NM 87110 | 2013-08-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215550199 | Sabrina Jennifer Lujan | Counselor | 8401 Constitution Ave Nw, Albuquerque, NM 87110 | 2020-05-26 |
1649829318 | Robert D. Oliver | Technician | 2705 Texas Street Ne, Albuquerque, NM 87110 | 2019-09-05 |
1033770904 | Life Re-created LLC | Counselor | 3939 San Pedro Dr. Ne, Bld C, Ste 8, Albuquerque, NM 87110 | 2019-06-21 |
1497319693 | Clear Choice Vision Care, LLC | Optometrist | 6600 Menaul Blve Ne, Suite M5a, Albuquerque, NM 87110 | 2019-04-24 |
1790257558 | Diana M Nicolas | Dietitian, Registered | 8300 Constitution Ave Ne Bld D, Albuquerque, NM 87110 | 2018-12-18 |
1689168403 | Robin N Hermes, Md, PC | Anesthesiology | 2440 Lousiana Blvd. Ne, Ste 580, Albuquerque, NM 87110 | 2018-06-15 |
1710481726 | Desert Mountain Eyecare LLC | Optometrist | 5504 Menaul Blvd Ne Ste Aandb, Albuquerque, NM 87110 | 2018-03-23 |
1659873131 | Amanda Lacasse | Registered Nurse | 6400 Uptown Blvd Ne Suite 360 West, Albuquerque, NM 87110 | 2018-03-01 |
1518485655 | Danielle Liegh Wyne | Counselor | 6121 Indian School Rd, Suite 141, Albuquerque, NM 87110 | 2017-09-08 |
1265957237 | Myrrhine Faller | Speech-Language Pathologist | 6020 Constitution Ave. Ne, Suite 4, Albuquerque, NM 87110 | 2017-08-10 |
Find all providers in zip 87110 |
Taxonomy Code | 103TP0016X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Prescribing (Medical) |
Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003218553 | Integrated Healthcare of New Mexico | Psychologist | 7632 William Moyers Ave Ne, Albuquerque, NM 87122-2765 | 2014-09-16 |
1245856913 | Paul King-miller Psyd Lpcc LLC | Psychologist | 11216 Brentwood Hills Blvd Ne, Albuquerque, NM 87112-3219 | 2020-06-18 |
1477585990 | Deborah Leslie Kos | Psychologist | 4810 Hardware Dr Ne, Albuquerque, NM 87109-2013 | 2006-07-07 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1417489378 | Primary Wellness Team Corporation | Psychologist | 5805 Mcnutt Rd, Ste D, Santa Teresa, NM 88008-8001 | 2017-03-30 |
1154877371 | J. Michael Mash Prescribing Psychologist LLC | Psychologist | 4155 State Road 68, Unit 6, Rancho De Taos, NM 87557 | 2016-08-28 |
1124466446 | Shekinah Foundation | Psychologist | 3001 S Wyoming Ave, Roswell, NM 88203-2326 | 2013-06-08 |
1902197098 | S M Cobb | Psychologist | 400 N Pennsylvania Ave Ste 990, Roswell, NM 88201-4754 | 2011-04-25 |
1730203860 | Pattijo N Velasquez | Psychologist | 1505 S Don Roser Dr, Ste. A, Las Cruces, NM 88011-4596 | 2007-03-16 |
1285232397 | Dr Tony J Kreuch LLC | Psychologist | 2204 Brothers Rd Ste B, Santa Fe, NM 87505-6975 | 2020-10-12 |
1548677669 | Winds of Change Mental Health Services, LLC | Psychologist | 108 E High St, Grants, NM 87020-2453 | 2014-07-21 |
1982024105 | Drw Behavioral Health Services, LLC | Psychologist | 1395 Missouri Ave, Las Cruces, NM 88001-5327 | 2014-04-27 |
City | ALBUQUERQUE |
Zip Code | 87110 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.