| Doctor Name: | MRS. KIMBERLY JANE ROACH |
| NPI Number: | 1174884670 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 12104 S 85th East Ave Bixby, OK - 740082703 |
| Business Phone Number: | 9187241473 |
| Business Fax Number: | |
| Mailing Address: | 4801 N Classen Blvd Ste 204, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731184622 |
| Phone Number: | 9187241473 |
| Fax Number: | |
| NPI Enumeration Date: | 05/31/2012 |
| NPI Last Update Date: | 03/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |