Active NPI
Kimberly Diane Judd, MA, LPC
- Professional Counselor
- Austin, TX
National Provider Identifier
1902045404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 15287
- Practice address
- 3625 Manchaca Rd Ste 202
Austin, TX 78704-5912 - Phone
- (512) 731-8105
- NPI assigned
- Feb 7, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 15287 | TX | Primary |
Addresses
Primary practice location
3625 Manchaca Rd Ste 202
Austin, TX 78704-5912
Mailing address
6102 Ginita LN
Austin, TX 78739-1639
Phone (512) 731-8105
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15287 | TX | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354665600000",
"number": "1902045404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6102 GINITA LN",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787391639",
"telephone_number": "512-731-8105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3625 MANCHACA RD STE 202",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787045912",
"telephone_number": "512-731-8105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUDD",
"first_name": "KIMBERLY",
"middle_name": "DIANE",
"credential": "MA, LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-07",
"last_updated": "2012-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "15287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.