Individual
STACEY KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
600 N JORDAN AVE, INDIANA UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICE, BLOOMINGTON, IN 47405-3190
(812) 855-5711
(812) 855-8447
Mailing address
600 N JORDAN AVE, INDIANA UNIVERSITY COUNSELING AND PSYCHOLOGICAL SERVICE, BLOOMINGTON, IN 47405-3190
(812) 855-5711
(812) 855-8447
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33005674A
IN
Other
Enumeration date
10/14/2009
Last updated
10/14/2009
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