Healthcare Provider Details

I. General information

NPI: 1669013413
Provider Name (Legal Business Name): KIMBERLY FLEISCHER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2019
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E RUSSELL ST
RHOME TX
76078-4487
US

IV. Provider business mailing address

110 E HIGHWAY 82
NOCONA TX
76255-2721
US

V. Phone/Fax

Practice location:
  • Phone: 817-592-9248
  • Fax:
Mailing address:
  • Phone: 469-556-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75581
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: