Provider Demographics
NPI:1497449482
Name:KIMBALL, RONDA (LPC)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:KIMBALL
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 1:8116 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-5563
Mailing Address - Country:US
Mailing Address - Phone:817-771-2728
Mailing Address - Fax:
Practice Address - Street 1:8116 TYLER DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-5563
Practice Address - Country:US
Practice Address - Phone:817-771-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional