Provider Demographics
NPI:1033645908
Name:ZIMMERMAN, ELISE (LMFT)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SELBY AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4528
Mailing Address - Country:US
Mailing Address - Phone:651-243-0623
Mailing Address - Fax:651-321-2558
Practice Address - Street 1:1595 SELBY AVE STE 208
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4528
Practice Address - Country:US
Practice Address - Phone:651-243-0623
Practice Address - Fax:651-321-2558
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI587-228106H00000X
MN3561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist