Provider Demographics
NPI:1104187244
Name:TANUVASA, KIMBERLY (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:TANUVASA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 IDYLLWILD CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2124
Mailing Address - Country:US
Mailing Address - Phone:214-457-8686
Mailing Address - Fax:888-688-1534
Practice Address - Street 1:9555 LEBANON RD STE 402
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6082
Practice Address - Country:US
Practice Address - Phone:469-777-3050
Practice Address - Fax:469-777-3454
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health