Provider Demographics
NPI:1164075776
Name:ZIMMERMAN, EVAN RAY (MED, BCBA, COBA)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:RAY
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:EVAN
Other - Middle Name:RAY
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, RBT
Mailing Address - Street 1:7500 SAN FELIPE ST STE 990
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1708
Mailing Address - Country:US
Mailing Address - Phone:833-288-4761
Mailing Address - Fax:
Practice Address - Street 1:3611 SOCIALVILLE FOSTER RD STE 101
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7353
Practice Address - Country:US
Practice Address - Phone:513-322-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267949103K00000X
1-20-46370103K00000X
OHCOBA.00849103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-46370OtherBCBA CERTIFICATE
RBT-15-01898OtherRBT CERTIFICATE