Provider Demographics
NPI:1669918900
Name:PATRICK, SHIMA S (MA, LMFT)
Entity type:Individual
Prefix:
First Name:SHIMA
Middle Name:S
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12407 N MOPAC EXPY # 250-116
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2475
Mailing Address - Country:US
Mailing Address - Phone:512-537-9082
Mailing Address - Fax:
Practice Address - Street 1:12407 N MOPAC EXPY # 250-116
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2475
Practice Address - Country:US
Practice Address - Phone:512-537-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health