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General NPI Number Information
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NPI Number | 1659097061
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Entity Type | Individual
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Provider Name | ARIEL KIMBLE
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 1945 W WILSON AVE STE 5115
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City | CHICAGO
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State | IL
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Zip | 60640-5258
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Country | US
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Telephone | 773-570-7631
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Fax |
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Provider Business Mailing Address
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Address Line | 2737 N SPAULDING AVE APT 208
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City | CHICAGO
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State | IL
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Zip | 60647-1355
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Country | US
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Telephone | 501-487-3664
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 208.000794
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License Number State |
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