Jessica Kim, LMHC
Individual provider Active NPI Mental Health Counselor · Rutland, VT
NPI 1710599360 · NPPES record last updated Sep 27, 2023
Key facts
- NPI
- 1710599360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 300 S Main St # 1020
Rutland, VT 05701-4907 - Phone
- (401) 484-0559
- Fax
- (401) 240-1207
- NPI assigned
- Aug 17, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 13, 2024 through Mar 13, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
300 S Main St # 1020
Rutland, VT 05701-4907
Mailing address
300 S Main St # 1020
Rutland, VT 05701-4907
Phone (401) 484-0559
Other practice location 1
22 Parsonage St Ste 310
Providence, RI 02903-4758
Phone (401) 484-0559
Other providers in Rutland, VT
- Ali J Kenyon
- Christina Huth Keshava
- Praveen H. Keshava
- Kevin Kiefaber
- Meredith A Kiesel
- Nicole Kimbrough
- Casey Hanley Kincade
- Caitlin Eva King
- Kimberly Dawn King
- Arnold Kirbach Jr.
All providers in Rutland, VT · Mental Health Counselor in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.