Individual
MRS. DIANE MARY KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1550 NE LOOP 410, SUITE 200, SAN ANTONIO, TX 78209-1610
(210) 385-0063
(210) 333-0565
Mailing address
522 MYSTIC SHORES BLVD, SPRING BRANCH, TX 78070-5240
(210) 385-0063
(210) 333-0565
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
24284
TX
106H00000X
Marriage & Family Therapist
Primary
24284
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00S99X
BCBS PROVIDER NUMBER
TX
01
—
24284
TX STATE BD OF EXAM SW
TX
Enumeration date
08/29/2006
Last updated
09/11/2025
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