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NPI Code Detail

MEDICARE: KIMBERLY GOULD FRY LMFT

MEDICARE: KIMBERLY GOULD FRY LMFT
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
1106H00000XMarriage & Family Therapist202865

General Provider Information

NPI Number : 1740846310
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY GOULD FRY LMFT
Provider Business Mailing Address
First Line : 6104 TOSCANA AVE
Second Line :
City : AUSTIN
State : TX
Zip : 78724-6249
Country : US
Telephone Number : 512-387-1398
Fax Number :
Provider Business Practice Location Address
First Line : 601 FARLEY DR
Second Line :
City : AUSTIN
State : TX
Zip : 78753-3114
Country : US
Telephone Number : 704-975-8613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2019
Last Update Date : 08/16/2021

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Directions to “ KIMBERLY GOULD FRY LMFT” Practice Location

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