Healthcare Provider Details

I. General information

NPI: 1063213163
Provider Name (Legal Business Name): ZIMMERMANN C&C GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MAIN ST
POLSON MT
59860-2167
US

IV. Provider business mailing address

48901 US HIGHWAY 93 STE A-270
POLSON MT
59860-7472
US

V. Phone/Fax

Practice location:
  • Phone: 626-869-6069
  • Fax:
Mailing address:
  • Phone: 425-308-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN ZIMMERMANN
Title or Position: COUNSELOR
Credential: LCPC
Phone: 425-308-2107