Provider Demographics
NPI:1629752415
Name:CARPENTER-MCKINNERNEY, KIMBERLEE J (MA, LPC)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:J
Last Name:CARPENTER-MCKINNERNEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2935
Mailing Address - Country:US
Mailing Address - Phone:817-565-7743
Mailing Address - Fax:
Practice Address - Street 1:106 AUSTIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-3381
Practice Address - Country:US
Practice Address - Phone:817-565-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135752101YM0800X
TX90673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health