Provider Demographics
NPI:1598024663
Name:KIMBELL, SHERRI LYNN (MA, LPC, PHDC)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:KIMBELL
Suffix:
Gender:F
Credentials:MA, LPC, PHDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 W ORMONDE RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8409
Mailing Address - Country:US
Mailing Address - Phone:303-717-3261
Mailing Address - Fax:
Practice Address - Street 1:1411 MARSH ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2908
Practice Address - Country:US
Practice Address - Phone:303-717-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker