Provider Demographics
NPI:1144092594
Name:STANLEY, KYMBER (LLMSW)
Entity type:Individual
Prefix:
First Name:KYMBER
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 LANSING AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2192
Mailing Address - Country:US
Mailing Address - Phone:517-817-4083
Mailing Address - Fax:
Practice Address - Street 1:405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MI
Practice Address - Zip Code:49237-9737
Practice Address - Country:US
Practice Address - Phone:517-817-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511057531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical