Provider Demographics
NPI:1497144356
Name:KIMBERLY CAPSTRAW, LMFT
Entity Type:Organization
Organization Name:KIMBERLY CAPSTRAW, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MARRIAGE AND FAMILY THERAPIS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:WESTBROOK
Authorized Official - Last Name:CAPSTRAW
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:407-227-9245
Mailing Address - Street 1:27198 WOODHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9615
Mailing Address - Country:US
Mailing Address - Phone:407-227-9245
Mailing Address - Fax:352-735-1551
Practice Address - Street 1:115 E 4TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5550
Practice Address - Country:US
Practice Address - Phone:407-227-9245
Practice Address - Fax:352-735-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty