Provider Demographics
NPI:1750772208
Name:ZIMMER, BRANDI SHAY (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:SHAY
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:
Other - Last Name:ZIMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:813 W 11TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2057
Mailing Address - Country:US
Mailing Address - Phone:512-589-1241
Mailing Address - Fax:
Practice Address - Street 1:813 W 11TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2057
Practice Address - Country:US
Practice Address - Phone:512-589-1241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical