Provider Demographics
NPI:1679133367
Name:KLAGES, KIMBERLY SYLVIA (PSYD, LP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SYLVIA
Last Name:KLAGES
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CANYON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-3701
Mailing Address - Country:US
Mailing Address - Phone:490-200-2220
Mailing Address - Fax:409-440-3344
Practice Address - Street 1:4749 ODOM RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7080
Practice Address - Country:US
Practice Address - Phone:409-200-2220
Practice Address - Fax:409-440-3344
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4159-226101YP2500X
TX40747103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional