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General NPI Number Information
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NPI Number | 1588928048
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Entity Type | Organization
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Legal Business Name | KIMBERLEE DAUGHTRY LPC PLLC
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 4081 DEZAVALA RD SUITE 101
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2082
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Country | US
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Telephone | 210-865-2903
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Fax | 210-957-7168
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Provider Business Mailing Address
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Address Line | 4081 DEZAVALA RD SUITE 101
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2082
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Country | US
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Telephone | 210-865-2903
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Fax | 210-957-7168
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. KIMBERLEE DAUGHTRY
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Credential | M.A.
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Telephone | 210-865-2903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 66779
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License Number State | TX
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