Provider Demographics
NPI:1023890811
Name:SMITH, KIMBERLY JILL (LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JILL
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 RIVERMOOR CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-9562
Mailing Address - Country:US
Mailing Address - Phone:254-855-5147
Mailing Address - Fax:
Practice Address - Street 1:620 STONEGLEN DR STE B
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3625
Practice Address - Country:US
Practice Address - Phone:817-562-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional