Doctor Name: | PATRICIA JOAN KIMBALL |
NPI Number: | 1669777181 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 178.006676 |
Business Practice Address: | 1375 Benton St Second Floor Crete, IL - 604172850 |
Business Phone Number: | 7087046973 |
Business Fax Number: | 7084815466 |
Mailing Address: | 1375 Benton St, Second Floor CRETE |
State: | IL |
Postal Code: | 604172850 |
Phone Number: | 7087046973 |
Fax Number: | 7084815466 |
NPI Enumeration Date: | 01/13/2011 |
NPI Last Update Date: | 01/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178.006676 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |