Provider Demographics
NPI:1669789277
Name:KIMBALL, DAN W (LPC)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:W
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E BROADWAY BLVD STE 202-14
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1720
Mailing Address - Country:US
Mailing Address - Phone:602-999-1243
Mailing Address - Fax:602-999-1243
Practice Address - Street 1:64 E BROADWAY BLVD STE 202-14
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1720
Practice Address - Country:US
Practice Address - Phone:602-999-1243
Practice Address - Fax:602-999-1243
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional