Kimberly Kaye Asner-Self, ED.D., NCC, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.004440 Issued in IL

Practice address

109 Lou Ann Dr
Herrin, IL 62948-3733

Phone

(618) 988-1330

Fax

(618) 988-8321

NPI assigned

Aug 27, 2012

Last updated

Aug 27, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1346025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346025600000",
    "number": "1992053771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 WHAM DR",
            "address_2": "MAIL CODE 4618",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629014313",
            "telephone_number": "618-453-2311",
            "fax_number": "618-453-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 LOU ANN DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483733",
            "telephone_number": "618-988-1330",
            "fax_number": "618-988-8321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ASNER-SELF",
        "first_name": "KIMBERLY",
        "middle_name": "KAYE",
        "name_prefix": "Prof.",
        "credential": "ED.D., NCC, LCPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-27",
        "last_updated": "2012-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.004440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Herrin, IL
• Providers in Herrin, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.