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General NPI Number Information
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NPI Number | 1386269520
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Entity Type | Individual
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Provider Name | KIMBERLY WOOTEN LPC-I, ATR-P
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Gender | Female
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Dates
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Enumeration Date | 06/13/2020
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Last Update Date | 06/13/2020
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Provider Practice Location Address
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Address Line | 275 APACHE TRL
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City | BERTRAM
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State | TX
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Zip | 78605-3655
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Country | US
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Telephone | 512-937-3240
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Fax |
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Provider Business Mailing Address
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Address Line | 275 APACHE TRL
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City | BERTRAM
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State | TX
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Zip | 78605-3655
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Country | US
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Telephone |
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Fax |
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | TX
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