Most Relevant Information
Provider Data
| NPI Number: | 1003434291 |
| Provider Name: | MADISON KIMBRELL MSW QMHP |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/14/2020 |
| Last Updated: | 07/14/2020 |
Provider Practice Location
101 OLIVER ST
VIENNA
IL
629951660
Practice Location Phone/Fax
| Phone: | 6186582611 |
| Fax: | 6186582501 |
Provider Mailing Location
101 OLIVER ST
VIENNA
IL
629951660
Provider Mailing Phone/Fax
| Phone: | 6186582611 |
| Fax: | 6186582501 |