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NPI Code Detail

MEDICARE: JANICE LEIGH KIMBALL

MEDICARE: JANICE LEIGH KIMBALL
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1326779240
Entity Type Code : Organization
Provider Name (Legal Business Name) : JANICE LEIGH KIMBALL
Provider Business Mailing Address
First Line : 3000 W MEMORIAL RD STE 218
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-6103
Country : US
Telephone Number : 405-400-9991
Fax Number :
Provider Business Practice Location Address
First Line : 3000 W MEMORIAL RD STE 218
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-6103
Country : US
Telephone Number : 405-400-9991
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JANICE LEIGH KIMBALL
Credential : LCSW
Telephone Number : 405-400-9991
Provider Enumeration Date : 06/21/2022
Last Update Date : 08/04/2022

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