MEDICARE: MR. SHAWN EDWARD ZEIMETZ LMFT

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
1	106H00000X	Marriage & Family Therapist	98111	NM

General Provider Information

NPI Number	:	1952477390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN EDWARD ZEIMETZ LMFT

Provider Business Mailing Address
First Line	:	8401 SPAIN RD NE APT 20E
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2013
Country	:	US
Telephone Number	:	505-873-1604
Fax Number	:	505-877-3533

Provider Business Practice Location Address
First Line	:	1710 EL CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4502
Country	:	US
Telephone Number	:	505-873-1604
Fax Number	:	505-877-3533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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