Provider Demographics
NPI:1538872890
Name:MAIN MUNOZ, KIMBERLEE ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ANNE
Last Name:MAIN MUNOZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 MEADOW PARK CIR APT 78
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-7855
Mailing Address - Country:US
Mailing Address - Phone:817-675-6340
Mailing Address - Fax:
Practice Address - Street 1:2512 MEADOW PARK CIR APT 78
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-7855
Practice Address - Country:US
Practice Address - Phone:817-675-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62267104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker