Provider Demographics
NPI:1205976529
Name:ZANDER, KIMBERLY SHAW (LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHAW
Last Name:ZANDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7543 BOSQUE BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3778
Mailing Address - Country:US
Mailing Address - Phone:254-744-5366
Mailing Address - Fax:254-732-3432
Practice Address - Street 1:7543 BOSQUE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3778
Practice Address - Country:US
Practice Address - Phone:254-744-5366
Practice Address - Fax:254-732-3432
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional