Provider Demographics
NPI:1891202917
Name:KIM VILLABONA, PSY.D
Entity Type:Organization
Organization Name:KIM VILLABONA, PSY.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSY D
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLABONA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:956-800-5679
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:956-322-4415
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:956-322-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294478702Medicaid