MEDICARE: KATIE KIMBROUGH LPC

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
1	101YP2500X	Professional Counselor	37PC00992000	NJ

General Provider Information

NPI Number	:	1114782448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE KIMBROUGH LPC

Provider Business Mailing Address
First Line	:	137 5TH AVE
Second Line	:
City	:	NEPTUNE CITY
State	:	NJ
Zip	:	07753-6375
Country	:	US
Telephone Number	:	760-397-3209
Fax Number	:

Provider Business Practice Location Address
First Line	:	337 DRUM POINT RD STE 2B
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6885
Country	:	US
Telephone Number	:	760-397-3209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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