Individual
DR. CHARLES A. KIMBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, HSPP
Contact information
Practice address
655 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5523
(812) 355-5890
(812) 355-5895
Mailing address
655 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5523
(812) 355-5890
(812) 355-5895
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20040582
IN
103T00000X
Psychologist
33522
TX
103TC0700X
Clinical Psychologist
Primary
20040582
IN
103TC0700X
Clinical Psychologist
33522
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316234
ANTHEM
—
05
—
100332490A
—
IN
Enumeration date
03/04/2006
Last updated
10/29/2008
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