Healthcare Provider Details

I. General information

NPI: 1396948816
Provider Name (Legal Business Name): ELAINE LOUISE ZIMMERMAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B2ND
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-8333
  • Fax: 937-734-9830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number292
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5361
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2505738
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: