Provider Demographics
NPI:1124196019
Name:KIMBLEY, GARY LEE (EDD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:KIMBLEY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 18TH PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416
Mailing Address - Country:US
Mailing Address - Phone:806-791-1929
Mailing Address - Fax:806-744-7871
Practice Address - Street 1:1105 38TH
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412
Practice Address - Country:US
Practice Address - Phone:806-747-2664
Practice Address - Fax:806-744-7871
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional