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NPI Code Detail

MEDICARE: MRS. KIMBERLY LAURISTON LCSW

MEDICARE: MRS. KIMBERLY LAURISTON LCSW
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
11041C0700XClinical Social Worker65682TX

General Provider Information

NPI Number : 1679429351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY LAURISTON LCSW
Provider Business Mailing Address
First Line : 7945 GAULT ST APT 201
Second Line :
City : AUSTIN
State : TX
Zip : 78757-8406
Country : US
Telephone Number : 512-537-6239
Fax Number :
Provider Business Practice Location Address
First Line : 5900 BALCONES DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4298
Country : US
Telephone Number : 737-374-7212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 04/15/2026

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