Organization Name: | PRACTICE OF CLINICAL PSYCHOLOGY INC |
NPI Number: | 1033142757 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY LEE ZIMMERMAN (PRESIDENT/TREASURER) |
Mailing Address: | 1000 W Market St Lima |
State: | OH US |
Postal Code: | 458052730 |
Phone Number: | 4192275515 |
Fax Number: | 4192278827 |
NPI Enumeration Date: | 07/08/2006 |
NPI Last Update Date: | 11/24/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1484 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |