MEDICARE: LINDA L. KIMMEL MA, 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	101YM0800X	Mental Health Counselor	6401008345	MI

General Provider Information

NPI Number	:	1235164799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA L. KIMMEL MA, LPC

Provider Business Mailing Address
First Line	:	675 E. EATON HWY
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849
Country	:	US
Telephone Number	:	616-902-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 4TH AVE
Second Line	:
City	:	LAKE ODESSA
State	:	MI
Zip	:	48849-1020
Country	:	US
Telephone Number	:	616-374-0113
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/30/2022

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