Provider Demographics
NPI:1639458284
Name:VILLABONA, KIM (PSYD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:VILLABONA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 QUINCE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2445
Mailing Address - Country:US
Mailing Address - Phone:956-800-5679
Mailing Address - Fax:
Practice Address - Street 1:2616 BUDDY OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6900
Practice Address - Country:US
Practice Address - Phone:956-800-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist