Provider Demographics
NPI:1144978040
Name:DOUGLAS, KIMBERLY DESHAY (MA, MBC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DESHAY
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:MA, MBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4904 RIPPLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-1913
Mailing Address - Country:US
Mailing Address - Phone:832-427-8425
Mailing Address - Fax:
Practice Address - Street 1:6430 COURT RD BLDG A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4462
Practice Address - Country:US
Practice Address - Phone:325-391-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251B00000XAgenciesCase Management