Provider Demographics
NPI:1174734040
Name:KIMBALL, THOMAS GRIFF (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GRIFF
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10806 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5757
Mailing Address - Country:US
Mailing Address - Phone:806-773-4663
Mailing Address - Fax:
Practice Address - Street 1:8200 NASHVILLE AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1906
Practice Address - Country:US
Practice Address - Phone:806-773-4663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004944-042949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist