Provider Demographics
NPI:1609123819
Name:TRASK, KIMBERLY L (MS, CSC, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:L
Last Name:TRASK
Suffix:
Gender:F
Credentials:MS, CSC, NCC, LPC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:STEARNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1716 GRIFFIN LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8560
Mailing Address - Country:US
Mailing Address - Phone:817-965-5886
Mailing Address - Fax:866-929-1927
Practice Address - Street 1:1716 GRIFFIN LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8560
Practice Address - Country:US
Practice Address - Phone:817-965-5886
Practice Address - Fax:866-929-1927
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12428729OtherCAQH