Provider Demographics
NPI:1669456760
Name:CIMMER, JAY LOUIS (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:LOUIS
Last Name:CIMMER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4337 E BILL MALLORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8635
Mailing Address - Country:US
Mailing Address - Phone:812-322-3680
Mailing Address - Fax:
Practice Address - Street 1:30 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-1200
Practice Address - Country:US
Practice Address - Phone:812-384-3946
Practice Address - Fax:812-384-3948
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001529A106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000330621OtherANTHEM