=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639933591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIMBERLY GREGORY, LMSW AND ASSOCIATES CONSULTING GROUP, 'L. 'L .C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2024
-----------------------------------------------------
Last Update Date | 02/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 S. ROSE STREET SUITE #602
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-352-4287
-----------------------------------------------------
Fax | 269-385-8352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 S. ROSE STREET SUITE #602
-----------------------------------------------------
City | KALAMAZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-352-4287
-----------------------------------------------------
Fax | 269-385-8352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL DIRECTOR
-----------------------------------------------------
Name | MS. KIMBERLY M GREGORY
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 269-352-4287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------