Healthcare Provider Details

I. General information

NPI: 1770901118
Provider Name (Legal Business Name): KIMBERLY CAMPBELL TYREE LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7004 SECURITY BLVD STE 300-A36
WINDSOR MILL MD
21244-2557
US

IV. Provider business mailing address

7004 SECURITY BLVD STE 300-A36
WINDSOR MILL MD
21244-2557
US

V. Phone/Fax

Practice location:
  • Phone: 443-591-9884
  • Fax:
Mailing address:
  • Phone: 443-591-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5626
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC5626
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: