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NPI Code Detail

MEDICARE: KIMBER COUNCELL MA

MEDICARE: KIMBER COUNCELL MA
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
1103K00000XBehavior AnalystABA-B-10232436OR

General Provider Information

NPI Number : 1770067456
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBER COUNCELL MA
Provider Business Mailing Address
First Line : 7500 SAN FELIPE ST STE 990
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1708
Country : US
Telephone Number : 407-501-8641
Fax Number :
Provider Business Practice Location Address
First Line : 5457 SW CANYON CT
Second Line :
City : PORTLAND
State : OR
Zip : 97221-2401
Country : US
Telephone Number : 971-762-4463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2018
Last Update Date : 12/30/2025

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Directions to “ KIMBER COUNCELL MA” Practice Location

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