Provider Demographics
NPI:1407697899
Name:KIMBROUGH, REBECCA (NCC, LPC, BC-TMH)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KIMBROUGH
Suffix:
Gender:F
Credentials:NCC, LPC, BC-TMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8294 SELF CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-5756
Mailing Address - Country:US
Mailing Address - Phone:662-694-0443
Mailing Address - Fax:
Practice Address - Street 1:8294 SELF CREEK RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-5756
Practice Address - Country:US
Practice Address - Phone:662-694-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2069101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional