Healthcare Provider Details

I. General information

NPI: 1093928608
Provider Name (Legal Business Name): BRIAN TIMOTHY KIMBER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BRIAN TIMOTHY KIMBER MSW

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 ZUNI RD SE
ALBUQUERQUE NM
87108-3073
US

IV. Provider business mailing address

3124 SAN RAFAEL AVE SE
ALBUQUERQUE NM
87106-2348
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-8978
  • Fax:
Mailing address:
  • Phone: 505-265-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberI3674
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: