Healthcare Provider Details

I. General information

NPI: 1023528775
Provider Name (Legal Business Name): CATHLEEN KIMMEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CATHLEEN RICKS LPC

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10365 SEVERANCE DR
PARKER CO
80134-9104
US

IV. Provider business mailing address

10365 SEVERANCE DR
PARKER CO
80134-9104
US

V. Phone/Fax

Practice location:
  • Phone: 254-715-3595
  • Fax:
Mailing address:
  • Phone: 254-715-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: