Collis Kimbrough, LCSW

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

SW9190 Issued in FL

Legal business name

COLLIS KIMBROUGH, LCSW

Practice address

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

Phone

(954) 561-3112

NPI assigned

Apr 18, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Collis Kimbrough, LCSWNPI 1881830370

Title

Sole Proprietor/Owner

Phone

(954) 561-3112

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Collis Kimbrough, LCSW

  • Clinical Social Worker
  • Fort Lauderdale, FL
  • NPI 1881830370
  NPD (past) Authorized official

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334707200000",
    "number": "1972860799",
    "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": {
        "organization_name": "COLLIS KIMBROUGH, LCSW",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2012-04-18",
        "status": "A",
        "authorized_official_last_name": "KIMBROUGH",
        "authorized_official_first_name": "COLLIS",
        "authorized_official_title_or_position": "SOLE PROPRIETOR/OWNER",
        "authorized_official_telephone_number": "954-561-3112",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": "SW9190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yairy Marcela Collazos Woolnough
• Annie Michelle Collett, OD
• Anna Collier, MPT
• Anecia Roberta Collins, LCSW
• Leah Michelle Collins, RBT
• Liliana Andrea Collison, ARNP
• Isabella Alejandra Colombo Carrillo
• Colon and Rectal Surgery Associates
• Cristina Beatriz Colon Aponte, M.D.
• Karina Colon Martinez, MSN FNP

• Community/Behavioral Health Agency in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Community/Behavioral Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 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.

Verify at the official NPI Registry.