Provider Demographics
NPI:1184706103
Name:SOUZA, KATHERINE ZIMMER (PHD, LMFT)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ZIMMER
Last Name:SOUZA
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89440-0803
Mailing Address - Country:US
Mailing Address - Phone:775-842-2689
Mailing Address - Fax:
Practice Address - Street 1:310 H ST.
Practice Address - Street 2:
Practice Address - City:VIRGINIA CITY
Practice Address - State:NV
Practice Address - Zip Code:89440
Practice Address - Country:US
Practice Address - Phone:775-842-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0139621106H00000X
NV0941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist