Provider Demographics
NPI:1720524192
Name:LIM, KI (MS)
Entity Type:Individual
Prefix:
First Name:KI
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:1711 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9166
Mailing Address - Country:US
Mailing Address - Phone:267-269-5100
Mailing Address - Fax:
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE #101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9166
Practice Address - Country:US
Practice Address - Phone:267-269-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional