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General NPI Number Information
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NPI Number | 1104187244
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Entity Type | Individual
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Provider Name | KIMBERLY TANUVASA LPC
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Gender | Female
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 9555 LEBANON RD STE 402
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City | FRISCO
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State | TX
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Zip | 75035-6082
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Country | US
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Telephone | 469-777-3050
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Fax | 469-777-3454
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Provider Business Mailing Address
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Address Line | 1601 IDYLLWILD CT
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City | PLANO
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State | TX
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Zip | 75075-2124
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Country | US
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Telephone | 214-457-8686
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Fax | 888-688-1534
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64907
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License Number State | TX
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