Provider Demographics
NPI:1952479941
Name:CARTER, KIMBERLY S (LPC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:S
Last Name:CARTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 PARK GLN
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3411
Mailing Address - Country:US
Mailing Address - Phone:870-941-6002
Mailing Address - Fax:817-569-5998
Practice Address - Street 1:1527 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4706
Practice Address - Country:US
Practice Address - Phone:817-569-5911
Practice Address - Fax:817-569-5998
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0611079101YM0800X
TX64063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
8744LLOtherBLUE CROSS BLUE SHIELD
TX285623901Medicaid
TX285623902OtherMEDICAID CHSCN