Provider Demographics
NPI:1346259561
Name:KIMMEY, FREDA E (LPC)
Entity Type:Individual
Prefix:MS
First Name:FREDA
Middle Name:E
Last Name:KIMMEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 BLUFF SPRINGS RD
Mailing Address - Street 2:#911
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4273
Mailing Address - Country:US
Mailing Address - Phone:512-440-8845
Mailing Address - Fax:
Practice Address - Street 1:6307 BLUFF SPRINGS RD
Practice Address - Street 2:#911
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-4273
Practice Address - Country:US
Practice Address - Phone:512-440-8845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15792101YP2500X
TX00120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5324LCOtherLPC