Healthcare Provider Details

I. General information

NPI: 1083819106
Provider Name (Legal Business Name): KYLE KIMBRIEL STILL M.ED., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ELIZABETH KIMBRIEL STILL

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 MAIN ST
TUNICA MS
38676
US

IV. Provider business mailing address

PO BOX 1046
CLARKSDALE MS
38614-1046
US

V. Phone/Fax

Practice location:
  • Phone: 662-636-3222
  • Fax:
Mailing address:
  • Phone: 662-627-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1270
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: