Provider Demographics
NPI:1700494341
Name:LASSITER, KIMBERLY (BT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LASSITER
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4734
Mailing Address - Country:US
Mailing Address - Phone:325-704-4392
Mailing Address - Fax:
Practice Address - Street 1:4601 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4734
Practice Address - Country:US
Practice Address - Phone:325-704-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician