Provider Type Icon

COLLIS KIMBROUGH LCSW NPI 1972860799


NPI Information

NPI: 1972860799
Provider Name: COLLIS KIMBROUGH, LCSW
Classification: Community/Behavioral Health - 251S00000X
Entity Type: Organization
Address:
2655 E OAKLAND PARK BLVD
SUITE 2
FORT LAUDERDALE, FL
ZIP 33306
Phone: (954) 561-3112
Get Directions

COLLIS KIMBROUGH, LCSW is a community behavioral health in Fort Lauderdale, FL. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. COLLIS KIMBROUGH, LCSW NPI is 1972860799. The provider is registered as an organization entity type.

The provider's business location address is:

2655 E OAKLAND PARK BLVD
SUITE 2
FORT LAUDERDALE, FL
ZIP 33306-662
Phone: (954) 561-3112

The provider's authorized official is Collis Kimbrough .
The authorized official title is Sole Proprietor/owner and has the following contact phone number (954) 561-3112.

The enumeration date for this NPI number is 4/18/2012 and was last updated on 4/18/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthSW9190FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1CB665BMEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.