Provider Demographics
NPI:1578066643
Name:VETERANS COUNSELING CLINIC
Entity Type:Organization
Organization Name:VETERANS COUNSELING CLINIC
Other - Org Name:LANCE Y. ZIMMERMAN, PHD
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-393-7465
Mailing Address - Street 1:4126 S DEMAREE ST STE B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9514
Mailing Address - Country:US
Mailing Address - Phone:559-393-7465
Mailing Address - Fax:
Practice Address - Street 1:4126 S DEMAREE ST STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9514
Practice Address - Country:US
Practice Address - Phone:559-393-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27555305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service