MEDICARE: KATHY A ZIMMERMAN LPC, LMHC

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	101YM0800X	Mental Health Counselor	LH60224180	WA
2	101YP2500X	Professional Counselor	C2697	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LH60224180	OTHER	WA	LMHC
2	C2697	OTHER	OR	LPC
3	12306439	OTHER	OR	CAQH

General Provider Information

NPI Number	:	1861769473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY A ZIMMERMAN LPC, LMHC

Provider Business Mailing Address
First Line	:	806 NE 197TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-7972
Country	:	US
Telephone Number	:	503-833-2652
Fax Number	:

Provider Business Practice Location Address
First Line	:	4536 NE 116TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97220-1419
Country	:	US
Telephone Number	:	503-833-2652
Fax Number	:

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

Provider Enumeration Date	:	11/27/2011
Last Update Date	:	11/27/2011

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