Provider Demographics
NPI:1750795944
Name:KIMBALL CLINICAL SOLUTIONS LLC
Entity type:Organization
Organization Name:KIMBALL CLINICAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-803-0879
Mailing Address - Street 1:3323 W IVY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1524
Mailing Address - Country:US
Mailing Address - Phone:813-766-3100
Mailing Address - Fax:
Practice Address - Street 1:324 W BEARSS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1228
Practice Address - Country:US
Practice Address - Phone:888-899-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW100741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004066100Medicaid
FL004066100Medicaid