Kimberly Lorna Shin, CADC, ATR-BC, LPCC,

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPCC5691 Issued in CA

Practice address

831 Alamo Dr Ste 5C
Vacaville, CA 95688-5343

Phone

(707) 624-9767

NPI assigned

Jul 19, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1366730806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3468 NORWALK PL",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945342965",
            "telephone_number": "707-294-5545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 ALAMO DR STE 5C",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956885343",
            "telephone_number": "707-624-9767"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3468 Norwalk Pl",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CA",
            "postal_code": "945342965",
            "country_code": "US",
            "telephone_number": "707-294-5545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1286 Callen St",
            "address_purpose": "LOCATION",
            "city": "Vacaville",
            "state": "CA",
            "postal_code": "956883002",
            "country_code": "US",
            "telephone_number": "707-447-8982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "KIMBERLY",
        "middle_name": "LORNA",
        "name_prefix": "Ms.",
        "credential": "CADC, ATR-BC, LPCC,",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-19",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LPCC5691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Vacaville, CA
• Providers in Vacaville, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.