Provider Demographics
NPI:1043983281
Name:KIMBER, AVA ROSE (MS MA LMFT)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:ROSE
Last Name:KIMBER
Suffix:
Gender:F
Credentials:MS MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1402 S CUSTER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-1452
Mailing Address - Country:US
Mailing Address - Phone:469-712-9134
Mailing Address - Fax:469-631-0888
Practice Address - Street 1:1402 S CUSTER RD STE 204
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-1452
Practice Address - Country:US
Practice Address - Phone:469-712-9134
Practice Address - Fax:469-631-0888
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203492OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL