Provider Demographics
NPI:1619503497
Name:KIM PRADERAS PLLC
Entity Type:Organization
Organization Name:KIM PRADERAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADERAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-458-2606
Mailing Address - Street 1:3301 NORTHLAND DR STE 320
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4952
Mailing Address - Country:US
Mailing Address - Phone:512-458-2606
Mailing Address - Fax:512-828-7042
Practice Address - Street 1:3301 NORTHLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4952
Practice Address - Country:US
Practice Address - Phone:512-458-2606
Practice Address - Fax:512-828-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty