1013037381 NPI number — BRENDA SUSAN KARIMALIS LPC, NCC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013037381 NPI number — BRENDA SUSAN KARIMALIS LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARIMALIS
Provider First Name:
BRENDA
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013037381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 BROADWAY
Provider Second Line Business Mailing Address:
UNIT 313
Provider Business Mailing Address City Name:
ALAMO HEIGHTS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78209-2357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-289-5557
Provider Business Mailing Address Fax Number:
210-745-4217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 BROADWAY
Provider Second Line Business Practice Location Address:
UNIT 313
Provider Business Practice Location Address City Name:
ALAMO HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78209-2357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-289-5557
Provider Business Practice Location Address Fax Number:
210-745-4217
Provider Enumeration Date:
03/30/2007

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:  17293 , 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)

  • Identifier: 162894301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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