Provider Demographics
NPI:1326269481
Name:CLARK-WASHINGTON, KIMBERLY (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:CLARK-WASHINGTON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:9115 NEWBURGH DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:281-734-5969
Mailing Address - Fax:
Practice Address - Street 1:9115 NEWBURGH DRIVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-734-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178888702Medicaid
TX1788887Medicaid
TX7254LCOtherBLUECROSS BLUESHIELD