Provider Demographics
NPI:1659500353
Name:ZIMMERMAN, STEPHANIE R (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
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 1:644 POLLASKY AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1883
Mailing Address - Country:US
Mailing Address - Phone:559-312-7779
Mailing Address - Fax:
Practice Address - Street 1:644 POLLASKY AVE STE 203
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1883
Practice Address - Country:US
Practice Address - Phone:559-387-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT51755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist