MEDICARE: TERESA MARIE ZIMMERMAN PRICE M.S.

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	101YP2500X	Professional Counselor	4547	LA
2	101YP2500X	Professional Counselor	LH60098274	WA

General Provider Information

NPI Number	:	1568644037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MARIE ZIMMERMAN PRICE M.S.

Provider Business Mailing Address
First Line	:	263 HOLLY GROVE ROAD
Second Line	:	P.O. BOX 341
City	:	ANACOCO
State	:	LA
Zip	:	71403
Country	:	US
Telephone Number	:	337-353-8675
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 HOLLY GROVE ROAD
Second Line	:
City	:	ANACOCO
State	:	LA
Zip	:	71403
Country	:	US
Telephone Number	:	337-353-8545
Fax Number	:

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

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/09/2009

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