Active NPI
Jonathan Kimball
- Professional Counselor
- Liberty, MO
National Provider Identifier
1487393526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 04761
- Practice address
- 17 E Kansas St Ste 200
Liberty, MO 64068-2372 - Phone
- (816) 724-5232
- NPI assigned
- May 27, 2022
- Last updated
- Apr 28, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | NU | ||
| Professional Counselor | 101YP2500X | 04761 | KS | Primary |
Addresses
Primary practice location
17 E Kansas St Ste 200
Liberty, MO 64068-2372
Mailing address
17 E Kansas St Ste 200
Liberty, MO 64068-2372
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04761 | KS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653609600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1745798400000",
"number": "1487393526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17 E KANSAS ST STE 200",
"city": "LIBERTY",
"state": "MO",
"postal_code": "640682372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 E KANSAS ST STE 200",
"city": "LIBERTY",
"state": "MO",
"postal_code": "640682372",
"telephone_number": "816-724-5232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "JONATHAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-27",
"last_updated": "2025-04-28",
"certification_date": "2025-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KS",
"license": "04761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Liberty, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.