Provider Demographics
NPI:1154794675
Name:HALE, KIMBERLY RENEE (PHD, LBA, BCBA)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RENEE
Last Name:HALE
Suffix:
Gender:F
Credentials:PHD, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1709
Mailing Address - Country:US
Mailing Address - Phone:615-688-9504
Mailing Address - Fax:615-688-9503
Practice Address - Street 1:300 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1709
Practice Address - Country:US
Practice Address - Phone:615-688-9504
Practice Address - Fax:615-688-9503
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1007103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst