=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235164799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA L. KIMMEL MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 08/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 4TH AVE
-----------------------------------------------------
City | LAKE ODESSA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48849-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-374-0113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 E. EATON HWY
-----------------------------------------------------
City | LAKE ODESSA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-902-0213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6401008345
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------