Provider Demographics
NPI:1063595767
Name:KIMBREL, MARILYN PAYNE (LPCC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:PAYNE
Last Name:KIMBREL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 WALES AVE NW
Mailing Address - Street 2:SUITE K
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-0804
Mailing Address - Country:US
Mailing Address - Phone:330-833-2452
Mailing Address - Fax:330-833-2749
Practice Address - Street 1:2400 WALES AVE NW
Practice Address - Street 2:SUITE K
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-0804
Practice Address - Country:US
Practice Address - Phone:330-833-2452
Practice Address - Fax:330-833-2749
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health