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NPI Code Detail

MEDICARE: MRS. RACHAEL ANNA KIMBLE LMSW

MEDICARE: MRS. RACHAEL ANNA KIMBLE LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLMSW31395ID

General Provider Information

NPI Number : 1245524545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. RACHAEL ANNA KIMBLE LMSW
Provider Business Mailing Address
First Line : 317 W 6TH ST STE 208
Second Line :
City : MOSCOW
State : ID
Zip : 83843-2387
Country : US
Telephone Number : 208-882-5960
Fax Number : 208-882-0957
Provider Business Practice Location Address
First Line : 317 W 6TH ST STE 208
Second Line :
City : MOSCOW
State : ID
Zip : 83843-2387
Country : US
Telephone Number : 208-882-5960
Fax Number : 208-882-0957
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2011
Last Update Date : 06/03/2011

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