Healthcare Provider Details

I. General information

NPI: 1073807244
Provider Name (Legal Business Name): KIMBERLY LYNN BARRETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4928 HOMBERG DR SUITE A-4
KNOXVILLE TN
37919-5100
US

IV. Provider business mailing address

3181 LAKE BROOK BLVD
KNOXVILLE TN
37909-1143
US

V. Phone/Fax

Practice location:
  • Phone: 865-321-1177
  • Fax:
Mailing address:
  • Phone: 865-321-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5805
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: