Healthcare Provider Details

I. General information

NPI: 1679459556
Provider Name (Legal Business Name): KIMBERLY EAVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 NERREN DR
SILSBEE TX
77656-6183
US

IV. Provider business mailing address

1045 W CHANCE RD
LUMBERTON TX
77657-7113
US

V. Phone/Fax

Practice location:
  • Phone: 409-210-7210
  • Fax:
Mailing address:
  • Phone: 409-679-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number99702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: