Provider Demographics
NPI:1871952911
Name:DEREMER, KIM (LCDC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DEREMER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 BURNET RD STE A3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7044
Mailing Address - Country:US
Mailing Address - Phone:512-257-0066
Mailing Address - Fax:
Practice Address - Street 1:8711 BURNET RD STE A3
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7044
Practice Address - Country:US
Practice Address - Phone:512-257-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7177101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)