Provider Demographics
NPI:1225730385
Name:KIMBRIEL, JOHN (BCBA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KIMBRIEL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5334
Mailing Address - Country:US
Mailing Address - Phone:804-335-7697
Mailing Address - Fax:
Practice Address - Street 1:1516 E PALM VALLEY BLVD BLDG C
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4619
Practice Address - Country:US
Practice Address - Phone:512-733-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst