Active NPI
Mary Mikell Zimmerman, M.S.
- Professional Counselor
- Sandpoint, ID
National Provider Identifier
1023288974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-3664
- Practice address
- 804 Airport Way
Bonner Business Center
Sandpoint, ID 83864-8200 - Phone
- (208) 597-3553
- NPI assigned
- Mar 6, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-3664 | ID | Primary |
Addresses
Primary practice location
804 Airport Way
Bonner Business Center
Sandpoint, ID 83864-8200
Mailing address
804 Airport Way
Bonner Business Center
Sandpoint, ID 83864-8200
Phone (208) 597-3553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-3664 | ID | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Lake Counseling and Support Services, Inc. | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Sandpoint, ID
- NPI 1336316207
Professional
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207267200000",
"number": "1023288974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "804 AIRPORT WAY",
"address_2": "BONNER BUSINESS CENTER",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838648200",
"telephone_number": "208-597-3553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "804 AIRPORT WAY",
"address_2": "BONNER BUSINESS CENTER",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838648200",
"telephone_number": "208-597-3553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMERMAN",
"first_name": "MARY MIKELL",
"credential": "M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-06",
"last_updated": "2008-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-3664",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.