Healthcare Provider Details

I. General information

NPI: 1215245378
Provider Name (Legal Business Name): KIMBERLY ANNE CAOLO LPC, ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PRESTON RD
PLANO TX
75024-3214
US

IV. Provider business mailing address

7601 PRESTON RD PSYCHIATRY
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 214-755-3860
  • Fax: 214-755-3860
Mailing address:
  • Phone: 214-755-3860
  • Fax: 469-303-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65531
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: