Provider Demographics
NPI:1285916726
Name:RISLEY, KIMBERLY DENISE (LPC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:RISLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:DENISE
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12108 BATTLE BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1951
Mailing Address - Country:US
Mailing Address - Phone:512-924-2636
Mailing Address - Fax:
Practice Address - Street 1:12108 BATTLE BRIDGE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1951
Practice Address - Country:US
Practice Address - Phone:512-924-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional