Provider Demographics
NPI:1326779240
Name:JANICE LEIGH KIMBALL
Entity Type:Organization
Organization Name:JANICE LEIGH KIMBALL
Other - Org Name:JANICE L KIMBALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-400-9991
Mailing Address - Street 1:3000 W MEMORIAL RD STE 218
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-6103
Mailing Address - Country:US
Mailing Address - Phone:405-400-9991
Mailing Address - Fax:
Practice Address - Street 1:3000 W MEMORIAL RD STE 218
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6103
Practice Address - Country:US
Practice Address - Phone:405-400-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)