Provider Demographics
NPI:1760141378
Name:SURVIVORS STUDIO PLLC
Entity Type:Organization
Organization Name:SURVIVORS STUDIO PLLC
Other - Org Name:SURVIVORS STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:817-415-0511
Mailing Address - Street 1:1313 SOUTHEAST PKWY
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-4024
Mailing Address - Country:US
Mailing Address - Phone:817-415-0511
Mailing Address - Fax:
Practice Address - Street 1:1313 SOUTHEAST PKWY
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-4024
Practice Address - Country:US
Practice Address - Phone:817-415-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health