Provider Demographics
NPI:1639281207
Name:GOIDELL, KIMBERLEY ANNE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KIMBERLEY
Middle Name:ANNE
Last Name:GOIDELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-717-5400
Mailing Address - Fax:405-717-5467
Practice Address - Street 1:1205 HEALTH CENTER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6396
Practice Address - Country:US
Practice Address - Phone:405-717-5400
Practice Address - Fax:405-717-5467
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical