Provider Demographics
NPI:1003292632
Name:KIMBALL, VICKI LYNN
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E CENTER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4596
Mailing Address - Country:US
Mailing Address - Phone:406-300-1369
Mailing Address - Fax:
Practice Address - Street 1:249 E CENTER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4596
Practice Address - Country:US
Practice Address - Phone:406-300-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor