Provider Demographics
NPI:1497404206
Name:MINCEY, KIMBERLEE (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:MINCEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-5503
Mailing Address - Country:US
Mailing Address - Phone:361-825-3995
Mailing Address - Fax:
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 430
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4255
Practice Address - Country:US
Practice Address - Phone:956-373-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional