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NPI Code Detail

MEDICARE: RAEVIN KIMBLE

MEDICARE: RAEVIN KIMBLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1104768464
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAEVIN KIMBLE
Provider Business Mailing Address
First Line : 3650 MUDDY CREEK RD STE 100
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-2058
Country : US
Telephone Number : 513-347-0375
Fax Number : 513-347-0375
Provider Business Practice Location Address
First Line : 3650 MUDDY CREEK RD STE 100
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-2058
Country : US
Telephone Number : 513-347-0375
Fax Number : 513-347-0375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

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Directions to “ RAEVIN KIMBLE ” Practice Location

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