MEDICARE: MR. DAN W KIMBALL 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	LPC-11055	AZ

General Provider Information

NPI Number	:	1669789277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN W KIMBALL LPC

Provider Business Mailing Address
First Line	:	64 E BROADWAY BLVD STE 202-14
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1720
Country	:	US
Telephone Number	:	602-999-1243
Fax Number	:	602-999-1243

Provider Business Practice Location Address
First Line	:	64 E BROADWAY BLVD STE 202-14
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85701-1720
Country	:	US
Telephone Number	:	602-999-1243
Fax Number	:	602-999-1243

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/09/2023

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