Provider Demographics
NPI:1497473862
Name:ZIMMERMAN, KIMBERLY (PSYD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 FIESTA ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-3011
Mailing Address - Country:US
Mailing Address - Phone:512-262-9930
Mailing Address - Fax:
Practice Address - Street 1:1106 FIESTA ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3011
Practice Address - Country:US
Practice Address - Phone:512-262-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical