Provider Demographics
NPI:1073051298
Name:ZIMMER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 MEADOW DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1389
Mailing Address - Country:US
Mailing Address - Phone:419-947-4055
Mailing Address - Fax:419-947-4285
Practice Address - Street 1:950 MEADOW DR
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1389
Practice Address - Country:US
Practice Address - Phone:419-947-4055
Practice Address - Fax:419-947-4285
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH121069101YA0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)