Collis Kimbrough, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW 9190 Issued in FL

Practice address

2655 E Oakland Park Blvd
Suite 2
Fort Lauderdale, FL 33306-1662

Phone

(954) 561-3112

NPI assigned

Jan 5, 2009

Last updated

Nov 1, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Collis Kimbrough, LCSW

  • Community/Behavioral Health Agency
  • Fort Lauderdale, FL
  • NPI 1972860799
  NPD (past) Authorized official
• Richard L Travis, Inc

  dba center for human potential

  • Professional Counselor
  • Fort Lauderdale, FL
  • NPI 1609042613
  NPD (past)
• Timothy O'Connor, L.C.S.W., P.a.

  • Adult Mental Health Clinic/Center
  • Fort Lauderdale, FL
  • NPI 1821436130
  NPD (past)

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1881830370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 E OAKLAND PARK BLVD",
            "address_2": "SUITE 2",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061662",
            "telephone_number": "954-561-3112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 E OAKLAND PARK BLVD",
            "address_2": "SUITE 2",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333061662",
            "telephone_number": "954-561-3112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBROUGH",
        "first_name": "COLLIS",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-01-05",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW 9190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Kim
• Esther Seulgee Kim
• Jinhyuck Kim, DO
• Robert Kim
• Kima Corporation (Davie Boulevard Drugs)
• Courtney J Kimmons, PHARMD
• Kimquest LLC
• Juliana Kinabo
• Kind Kids Therapy Center LLC
• Lori D Kindle, DC

• Clinical Social Worker in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.