Provider Demographics
NPI:1841431152
Name:ZIMMERMAN, MARK L (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N ALDER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6221
Mailing Address - Country:US
Mailing Address - Phone:206-954-6776
Mailing Address - Fax:253-756-9782
Practice Address - Street 1:2610 N ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-6221
Practice Address - Country:US
Practice Address - Phone:206-954-6776
Practice Address - Fax:253-756-9782
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2060832Medicaid