Provider Demographics
NPI:1033447180
Name:MITCHELL, KIMBERLY SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YATES CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:66783-1444
Mailing Address - Country:US
Mailing Address - Phone:620-625-2746
Mailing Address - Fax:888-802-7094
Practice Address - Street 1:204 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YATES CENTER
Practice Address - State:KS
Practice Address - Zip Code:66783-1444
Practice Address - Country:US
Practice Address - Phone:620-625-2746
Practice Address - Fax:888-802-7094
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker