Provider Demographics
NPI:1255439535
Name:KIMBALL, DANIEL J (LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:905 JEFFERSON ST
Mailing Address - Street 2:STE 410
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-7900
Mailing Address - Country:US
Mailing Address - Phone:337-234-4912
Mailing Address - Fax:337-234-6064
Practice Address - Street 1:905 JEFFERSON ST
Practice Address - Street 2:STE 410
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-7900
Practice Address - Country:US
Practice Address - Phone:337-234-4912
Practice Address - Fax:337-234-6064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X054Medicare ID - Type Unspecified