Provider Demographics
NPI:1225447337
Name:KIMBROUGH, DONNA (MA,LPC,BCBA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:MA,LPC,BCBA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:ALMEIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,LPC, BCBA
Mailing Address - Street 1:133 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5146
Mailing Address - Country:US
Mailing Address - Phone:817-249-8100
Mailing Address - Fax:817-249-2215
Practice Address - Street 1:3100 PREMIER DR
Practice Address - Street 2:234
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2661
Practice Address - Country:US
Practice Address - Phone:817-249-4807
Practice Address - Fax:817-249-2215
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-13303103K00000X
TX71195101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor