Provider Demographics
NPI:1508661174
Name:WILLIAMS, KIMBERLEY L (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MURCHISON
Mailing Address - State:TX
Mailing Address - Zip Code:75778-0158
Mailing Address - Country:US
Mailing Address - Phone:903-330-9592
Mailing Address - Fax:903-470-7373
Practice Address - Street 1:10697 COUNTY ROAD 159
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3327
Practice Address - Country:US
Practice Address - Phone:903-330-9592
Practice Address - Fax:903-470-7373
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty