MEDICARE: MS. SHAULEA REJEEN KIMMEL 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
1	104100000X	Social Worker	62186	TX
2	1041C0700X	Clinical Social Worker	62186	TX

General Provider Information

NPI Number	:	1841841699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAULEA REJEEN KIMMEL LCSW

Provider Business Mailing Address
First Line	:	9802 DUGAS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-1052
Country	:	US
Telephone Number	:	210-618-4896
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 N SAM HOUSTON PKWY E STE 1100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-2413
Country	:	US
Telephone Number	:	713-715-5001
Fax Number	:	713-715-5085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	05/20/2024

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