Kimberly Kaye Asner-Self, ED.D., NCC, LCPC
Individual provider Active NPI Professional Counselor · Herrin, IL
NPI 1992053771 · NPPES record last updated Aug 27, 2012
Key facts
- NPI
- 1992053771
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 180.004440 (IL)
- Practice address
- 109 Lou Ann Dr
Herrin, IL 62948-3733 - Phone
- (618) 988-1330
- Fax
- (618) 988-8321
- NPI assigned
- Aug 27, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180.004440 | IL | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180.004440 | IL | Yes |
Addresses
Primary practice location
109 Lou Ann Dr
Herrin, IL 62948-3733
Mailing address
625 Wham Dr
Mail Code 4618
Carbondale, IL 62901-4313
Phone (618) 453-2311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180.004440 | Other | IL | LICENSED CLINICAL PROFESSION COUNSELOR |
Other providers in Herrin, IL
- Lianne Anderson
- Misty Layne Anderson
- Angela Baxter LLC
- Angela Marie Arnold
- Don Cassidy Arnold II
- Mark Austin
- Stephanie Brooks Austin
- Sharon Ball
- Lerin Banas
- Adam Vincent Barciszewski
All providers in Herrin, IL · Professional Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.