Provider Demographics
NPI:1316264914
Name:ROOD, KIMBERLY SUE (LPC, NCC, LCDC-CI)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:ROOD
Suffix:
Gender:F
Credentials:LPC, NCC, LCDC-CI
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SUE
Other - Last Name:RICARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC, LCDC-CI
Mailing Address - Street 1:4301 WILSON STREET
Mailing Address - Street 2:
Mailing Address - City:FT. SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-558-2134
Mailing Address - Fax:580-558-2314
Practice Address - Street 1:4301 WILSON STREET
Practice Address - Street 2:
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-558-2134
Practice Address - Fax:580-558-2314
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional