Provider Demographics
NPI:1205699451
Name:TRIVEDI-ZIEMBA, PURVIBEN KISHORKUMAR (LMFT-IT)
Entity type:Individual
Prefix:
First Name:PURVIBEN
Middle Name:KISHORKUMAR
Last Name:TRIVEDI-ZIEMBA
Suffix:
Gender:F
Credentials:LMFT-IT
Other - Prefix:
Other - First Name:PURVIE
Other - Middle Name:KISHORKUMAR
Other - Last Name:TRIVEDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2211 OREGON ST STE N
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-7001
Mailing Address - Country:US
Mailing Address - Phone:920-479-1996
Mailing Address - Fax:920-479-1997
Practice Address - Street 1:2211 OREGON ST STE N
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-7001
Practice Address - Country:US
Practice Address - Phone:920-479-1996
Practice Address - Fax:920-479-1997
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1058-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty