| Kimberly Clough | |
|
1010 Tristan Ln Longview TX 75604-1862 | |
| (903) 918-6574 | |
| (903) 704-0980 |
| Full Name | Kimberly Clough |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1010 Tristan Ln, Longview, Texas |
| Authorized Official Name and Position | Kimberly Clough (CEO) |
| Authorized Official Contact | 9039186574 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly Clough 1010 Tristan Ln Longview TX 75604-1862 Ph: (903) 918-6574 | Kimberly Clough 1010 Tristan Ln Longview TX 75604-1862 Ph: (903) 918-6574 |
| NPI Number | 1003323726 |
|---|---|
| Provider Enumeration Date | 01/03/2018 |
| Last Update Date | 01/03/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003323726 | NPI | - | NPPES |
| 373636801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 59013 (Texas) | Primary |
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