Provider Demographics
NPI:1043927353
Name:KIMBRELL, ALESHA ANN (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:ANN
Last Name:KIMBRELL
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 E CAMELBACK RD STE 2969
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25615 N 131ST DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3501
Practice Address - Country:US
Practice Address - Phone:480-980-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-22-61362103K00000X
AZBEH-001039103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-22-61362OtherBACB CERTIFICATION
AZBEH-001039OtherSTATE OF ARIZONA BOARD OF PSYCHOLOGIST EXAMINERS