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General NPI Number Information
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NPI Number | 1013421619
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Entity Type | Organization
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Legal Business Name | MJ ZIMMERMAN LPCC, LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4916 4TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3949
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Country | US
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Telephone | 505-573-2339
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Fax |
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Provider Business Mailing Address
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Address Line | 4808 TEODOCIO ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-3359
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Country | US
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Telephone | 505-573-2339
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARY JANE ZIMMERMAN
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Credential | LPCC
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Telephone | 505-573-2339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0188201
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License Number State | NM
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