| Doctor Name: | MARY MIKELL ZIMMERMAN |
| NPI Number: | 1023288974 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. |
| License Number: | LPC-3664 |
| Business Practice Address: | 804 Airport Way Bonner Business Center Sandpoint, ID - 838648200 |
| Business Phone Number: | 2085973553 |
| Business Fax Number: | |
| Mailing Address: | 804 Airport Way, Bonner Business Center SANDPOINT |
| State: | ID |
| Postal Code: | 838648200 |
| Phone Number: | 2085973553 |
| Fax Number: | |
| NPI Enumeration Date: | 03/06/2008 |
| NPI Last Update Date: | 04/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC-3664 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |