Healthcare Provider Details

I. General information

NPI: 1346067626
Provider Name (Legal Business Name): KIMBERLE A TISH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N RIDGEWOOD DR
SEBRING FL
33870-7205
US

IV. Provider business mailing address

101 EASTVIEW RD
SEBRING FL
33870-1810
US

V. Phone/Fax

Practice location:
  • Phone: 863-576-9091
  • Fax: 305-418-7578
Mailing address:
  • Phone: 863-576-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: