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NPI Code Detail

MEDICARE: MR. CHARLES ALBERT ZIMMERLE LPC

MEDICARE: MR. CHARLES ALBERT ZIMMERLE LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor0006949OH

General Provider Information

NPI Number : 1255685038
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES ALBERT ZIMMERLE LPC
Provider Business Mailing Address
First Line : 2745 S SMITHVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45420-2668
Country : US
Telephone Number : 937-258-4256
Fax Number : 937-258-4261
Provider Business Practice Location Address
First Line : 2745 S SMITHVILLE RD
Second Line :
City : DAYTON
State : OH
Zip : 45420-2668
Country : US
Telephone Number : 937-258-4256
Fax Number : 937-258-4261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2012
Last Update Date : 11/01/2012

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