Provider Demographics
NPI:1255762886
Name:KIMEL, JEFFREY ALLAN (LPC, CSAC, ICS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:KIMEL
Suffix:
Gender:M
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N CARROLL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2762
Mailing Address - Country:US
Mailing Address - Phone:608-514-1672
Mailing Address - Fax:
Practice Address - Street 1:16 N CARROLL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2716
Practice Address - Country:US
Practice Address - Phone:262-898-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-08
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16013-132101YA0400X
WI1996 - 226101YP2500X
WI5797-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095265Medicaid