Healthcare Provider Details

I. General information

NPI: 1184706103
Provider Name (Legal Business Name): KATHERINE ZIMMER SOUZA PH.D., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 H ST.
VIRGINIA CITY NV
89440
US

IV. Provider business mailing address

PO BOX 803
VIRGINIA CITY NV
89440-0803
US

V. Phone/Fax

Practice location:
  • Phone: 775-842-2689
  • Fax:
Mailing address:
  • Phone: 775-842-2689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0139621
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0941
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: