Provider Demographics
NPI:1811508245
Name:KIMBLE, JUSTIN L (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:L
Last Name:KIMBLE
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W FIVE MILE PKWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4913
Mailing Address - Country:US
Mailing Address - Phone:214-585-5995
Mailing Address - Fax:
Practice Address - Street 1:806 W FIVE MILE PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4913
Practice Address - Country:US
Practice Address - Phone:214-585-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst