Provider Demographics
NPI:1164856746
Name:MATTHEWS, KIMBERLY D
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:MATTHEWS
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 1:8091 PINE ARBOR LN APT 104
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6780
Mailing Address - Country:US
Mailing Address - Phone:662-251-4246
Mailing Address - Fax:
Practice Address - Street 1:3041 GETWELL RD STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3737
Practice Address - Country:US
Practice Address - Phone:901-375-1050
Practice Address - Fax:901-375-1588
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor