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NPI Code Detail

MEDICARE: SHANNON MARIE KIMBRO LMHC

MEDICARE: SHANNON MARIE KIMBRO LMHC
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 Counselor006111NM

General Provider Information

NPI Number : 1265421622
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MARIE KIMBRO LMHC
Provider Business Mailing Address
First Line : 8612 SAN FRANCISCO RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-5006
Country : US
Telephone Number : 505-291-8352
Fax Number :
Provider Business Practice Location Address
First Line : 8612 SAN FRANCISCO RD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-5006
Country : US
Telephone Number : 505-291-8352
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 07/08/2007

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Directions to “ SHANNON MARIE KIMBRO LMHC” Practice Location

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