Provider Demographics
NPI:1225571052
Name:KIMBRELL, AMANDA (MS, LPC-MHSP)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:MS, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 IMPERIAL BLVD STE F200
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3341
Mailing Address - Country:US
Mailing Address - Phone:615-403-5180
Mailing Address - Fax:
Practice Address - Street 1:111 IMPERIAL BLVD STE F200
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3341
Practice Address - Country:US
Practice Address - Phone:615-682-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TN4881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor