Provider Demographics
NPI:1306662796
Name:BROWN, KIMBERLY NICHOLE (LPC/MHSP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:NICHOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 CALLABEE WAY UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4625
Mailing Address - Country:US
Mailing Address - Phone:615-200-7327
Mailing Address - Fax:
Practice Address - Street 1:214 OVERLOOK CIR STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8508
Practice Address - Country:US
Practice Address - Phone:615-200-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000006824101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional