Provider Demographics
NPI:1407421050
Name:HART, KYMBER LOREE (LCDC-ASSOCIATE)
Entity Type:Individual
Prefix:MS
First Name:KYMBER
Middle Name:LOREE
Last Name:HART
Suffix:
Gender:F
Credentials:LCDC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MCKINNEY AVE APT 413
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2309
Mailing Address - Country:US
Mailing Address - Phone:214-973-2094
Mailing Address - Fax:
Practice Address - Street 1:4144 N CENTRAL EXPY STE 850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3226
Practice Address - Country:US
Practice Address - Phone:214-973-2094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44603101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)