Provider Demographics
NPI:1972835825
Name:ZIMMERMAN, CYNTHIA (MS PPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MS PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-6625
Mailing Address - Country:US
Mailing Address - Phone:307-399-9191
Mailing Address - Fax:
Practice Address - Street 1:1575 N 4TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2091
Practice Address - Country:US
Practice Address - Phone:307-399-9191
Practice Address - Fax:307-399-9191
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1400101YP2500X
WY1400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor