Provider Demographics
NPI:1922045533
Name:WEAKS, KIMBERLY ALBIN (PHD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALBIN
Last Name:WEAKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ALBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 SW B AVE
Mailing Address - Street 2:C
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3954
Mailing Address - Country:US
Mailing Address - Phone:580-248-3900
Mailing Address - Fax:580-248-1987
Practice Address - Street 1:813 SW B AVE
Practice Address - Street 2:C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3954
Practice Address - Country:US
Practice Address - Phone:580-248-3900
Practice Address - Fax:580-248-1987
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK893103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling