Provider Demographics
NPI:1134562341
Name:MARIAN R. ZIMMERMAN PH.D., PA
Entity type:Organization
Organization Name:MARIAN R. ZIMMERMAN PH.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:241-618-1451
Mailing Address - Street 1:3550 PARKWOOD BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1903
Mailing Address - Country:US
Mailing Address - Phone:214-618-1451
Mailing Address - Fax:
Practice Address - Street 1:3550 PARKWOOD BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1903
Practice Address - Country:US
Practice Address - Phone:214-618-1451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty