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General NPI Number Information
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NPI Number | 1609256379
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Entity Type | Individual
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Provider Name | KIMBERLY HARRELSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 615 S NEW BALLAS RD MERCY KIDS
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8221
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Country | US
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Telephone | 314-308-0732
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BERRY HILL CT
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City | SAINT CHARLES
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State | MO
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Zip | 63303-4416
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2012019810
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 2012019810
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License Number State | MO
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