Doctor Name: | MR. LEE A KIMBLE |
NPI Number: | 1194050971 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1209 Kingston Dr Wharton, TX - 774885709 |
Business Phone Number: | 9792576737 |
Business Fax Number: | 9796360509 |
Mailing Address: | 1209 Kingston Dr, WHARTON |
State: | TX |
Postal Code: | 774885709 |
Phone Number: | 9792576737 |
Fax Number: | 9796360509 |
NPI Enumeration Date: | 10/12/2009 |
NPI Last Update Date: | 10/12/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |