Basic Information
| Provider Information | |||||||||
| NPI: | 1225447337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIMBROUGH | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA,LPC,BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALMEIDA | ||||||||
| OtherFirstName: | DONNA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA,LPC, BCBA | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 133 GLENDALE DR | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750195146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172498100 | ||||||||
| FaxNumber: | 8172492215 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 PREMIER DR | ||||||||
| Address2: | 234 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172494807 | ||||||||
| FaxNumber: | 8172492215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2014 | ||||||||
| LastUpdateDate: | 07/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-13-13303 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 101Y00000X | 71195 | TX | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.