Provider Demographics
NPI:1134396278
Name:FAILS, KIMYATTA GREATHOUSE (LPC,NCC,CAC)
Entity type:Individual
Prefix:
First Name:KIMYATTA
Middle Name:GREATHOUSE
Last Name:FAILS
Suffix:
Gender:F
Credentials:LPC,NCC,CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1333
Mailing Address - Country:US
Mailing Address - Phone:334-413-4055
Mailing Address - Fax:
Practice Address - Street 1:9505 COLLETON PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8436
Practice Address - Country:US
Practice Address - Phone:706-442-5372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6140101YA0400X
TX76321101YP2500X
CO3689101YP2500X
NC17750101YM0800X
AL3375101YP2500X
ID8637101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health