Provider Demographics
NPI:1629155270
Name:FERREN, KIMBERLY J (LPC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:FERREN
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:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75132-0736
Mailing Address - Country:US
Mailing Address - Phone:972-679-1622
Mailing Address - Fax:972-722-8009
Practice Address - Street 1:562 W RALPH HALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6644
Practice Address - Country:US
Practice Address - Phone:972-679-1622
Practice Address - Fax:972-722-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional