Provider Demographics
NPI:1841841699
Name:KIMMEL, SHAULEA REJEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHAULEA
Middle Name:REJEEN
Last Name:KIMMEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 DUGAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1052
Mailing Address - Country:US
Mailing Address - Phone:210-618-4896
Mailing Address - Fax:
Practice Address - Street 1:363 N SAM HOUSTON PKWY E STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2413
Practice Address - Country:US
Practice Address - Phone:713-715-5001
Practice Address - Fax:713-715-5085
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62186104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker