Provider Demographics
NPI:1578804225
Name:KIMBALL, LYNN ELLEN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5710
Mailing Address - Country:US
Mailing Address - Phone:575-491-2789
Mailing Address - Fax:
Practice Address - Street 1:1301 OREGON AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5710
Practice Address - Country:US
Practice Address - Phone:575-491-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0174941101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor