Provider Demographics
NPI:1225755838
Name:COLBERT, KIMBERLY LOREE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOREE
Last Name:COLBERT
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 1:5104 GREEN COVE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3845
Mailing Address - Country:US
Mailing Address - Phone:502-432-5557
Mailing Address - Fax:
Practice Address - Street 1:801 BARRET AVE STE 222
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1733
Practice Address - Country:US
Practice Address - Phone:502-658-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health