Organization
FAITHFULLY RESTORED
Active
Other names
Kimberly Clough
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY CLOUGH LCSW (CEO)
(903) 918-6574
Entity
Organization
Contact information
Practice address
1010 TRISTAN LN, LONGVIEW, TX 75604-1862
(903) 918-6574
(903) 704-0980
Mailing address
1010 TRISTAN LN, LONGVIEW, TX 75604-1862
(903) 918-6574
(903) 704-0980
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
59013
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
373636801
—
TX
Enumeration date
01/03/2018
Last updated
01/03/2018
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