1710169628 NPI number — VALINDA SUE ZIMMERMAN RN, MA, LPC

Table of content: VALINDA SUE ZIMMERMAN RN, MA, LPC (NPI 1710169628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710169628 NPI number — VALINDA SUE ZIMMERMAN RN, MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
VALINDA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROGERS
Provider Other First Name:
VALINDA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710169628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3237 RED OAK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-493-9429
Provider Business Mailing Address Fax Number:
817-796-1247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 CENTRAL DR STE 303
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021-5846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-493-9429
Provider Business Practice Location Address Fax Number:
817-796-1247
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  13312 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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