Kimberly Diane Fredrick, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

12080 Issued in TX

Practice address

4807 Spicewood Springs Rd Ste 1140
Austin, TX 78759-8479

Phone

(512) 843-7665

NPI assigned

Mar 31, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 9, 2024 through May 9, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Just Mind

  • Professional Counselor
  • Austin, TX
  • NPI 1962828236
  NPD
• Just Mind, LLC

  • Professional Counselor
  • Austin, TX
  • NPI 1962860544
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1497450456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4807 SPICEWOOD SPRINGS RD STE 1140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598479",
            "telephone_number": "512-843-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4807 SPICEWOOD SPRINGS RD STE 1140",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598479",
            "telephone_number": "512-843-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDRICK",
        "first_name": "KIMBERLY",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-03-31",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "12080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delora Marie Frederickson
• Ashlyn Archer Frederiksen, PA-C
• Leigh Anne Fredholm, MD
• Theresa Fredley, MS, FAAOMPT
• Fredrick Shaw DDS, PC
• Fredrickson Anesthesia Staffing Inc.
• Elizabeth A Fredrickson, LCSW
• Nichole Victoria Fredriksson Ellison, M.S. CCC-SLP
• Jeyton Freed
• Daniel Freedman

• Mental Health Counselor in Austin, TX
• Providers in Austin, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.