Individual
KIMBERLY A MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
331 SIJEN AVE, WHITEMAN AFB, MO 65305-1269
(660) 687-3143
Mailing address
331 SIJEN AVE, WHITEMAN AFB, MO 65305-1269
(660) 687-2150
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2016009943
MO
104100000X
Social Worker
8459
KS
1041C0700X
Clinical Social Worker
Primary
2017003630
MO
1041C0700X
Clinical Social Worker
4620
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017003630
STATE OF MISSOURI DIV OF PROF REGISTRATION STATE COMMITTEE FOR SOCIAL WORKERS
MO
01
—
4620
STATE OF KANSAS BEHAVIORAL SCIENCES REGULATORY BOARD
KS
Enumeration date
06/25/2012
Last updated
03/05/2024
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