MEDICARE: DR. C F KIMBERLING JR. PH.D.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1255477634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C F KIMBERLING JR. PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 19635
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73144-0635
Country	:	US
Telephone Number	:	405-692-2118
Fax Number	:	405-605-5816

Provider Business Practice Location Address
First Line	:	3035 NW 63RD ST
Second Line	:	STE 1010684
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3632
Country	:	US
Telephone Number	:	405-842-0684
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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