Provider Demographics
NPI:1598003329
Name:FERRELL, KIMBERLY D (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:FERRELL
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 1:2440 E 360TH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65685-8510
Mailing Address - Country:US
Mailing Address - Phone:417-298-5804
Mailing Address - Fax:
Practice Address - Street 1:201 S ASH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-8674
Practice Address - Country:US
Practice Address - Phone:417-345-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010032132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional