Basic Information
| Provider Information | |||||||||
| NPI: | 1043708753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBLE | ||||||||
| FirstName: | HAYLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11308 PRADERA DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787594520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125879615 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5910 COURTYARD DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787313341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123826359 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2018 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 50405 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.