Provider Demographics
NPI:1376880153
Name:SCOTT, KIMBERLY BALDWIN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BALDWIN
Last Name:SCOTT
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:HC 68 BOX 569
Mailing Address - Street 2:
Mailing Address - City:RINGOLD
Mailing Address - State:OK
Mailing Address - Zip Code:74754-9717
Mailing Address - Country:US
Mailing Address - Phone:580-372-1215
Mailing Address - Fax:
Practice Address - Street 1:HC 68 BOX 569
Practice Address - Street 2:
Practice Address - City:RINGOLD
Practice Address - State:OK
Practice Address - Zip Code:74754-9717
Practice Address - Country:US
Practice Address - Phone:580-372-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor