Provider Demographics
NPI:1669765004
Name:KIMBLE, BRITTNI MONTANA (MS)
Entity type:Individual
Prefix:MS
First Name:BRITTNI
Middle Name:MONTANA
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9650 ENSWORTH
Mailing Address - Street 2:159
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123
Mailing Address - Country:US
Mailing Address - Phone:701-465-7841
Mailing Address - Fax:
Practice Address - Street 1:9418 WEST LAKE MEAD
Practice Address - Street 2:316
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0842
Practice Address - Country:US
Practice Address - Phone:702-465-7841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
NVMI0954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst