Provider Demographics
NPI:1265421622
Name:KIMBRO, SHANNON MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:KIMBRO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 SAN FRANCISCO RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5006
Mailing Address - Country:US
Mailing Address - Phone:505-291-8352
Mailing Address - Fax:
Practice Address - Street 1:8612 SAN FRANCISCO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5006
Practice Address - Country:US
Practice Address - Phone:505-291-8352
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health