Provider Demographics
NPI:1265107429
Name:MEADOR, KIMBERLY (MA, LPA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MEADOR
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 PORTSMOUTH PL
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-6262
Mailing Address - Country:US
Mailing Address - Phone:903-819-2647
Mailing Address - Fax:
Practice Address - Street 1:3511 PORTSMOUTH PL
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-6262
Practice Address - Country:US
Practice Address - Phone:903-819-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist