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General NPI Number Information
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NPI Number | 1669084919
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Entity Type | Individual
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Provider Name | DENISE KIMBALL
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Gender | Female
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 215 SW 7TH ST
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City | REDMOND
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State | OR
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Zip | 97756-2113
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Country | US
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Telephone | 541-388-8459
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Fax | 541-388-8116
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Provider Business Mailing Address
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Address Line | 1333 NW 9TH ST
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City | PRINEVILLE
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State | OR
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Zip | 97754-1482
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Country | US
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Telephone | 541-388-8459
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Fax | 541-388-8116
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C8616
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License Number State | OR
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