Basic Information
| Provider Information | |||||||||
| NPI: | 1053454330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | CARLENE | ||||||||
| MiddleName: | BETTY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAVIS ZIMMERMAN | ||||||||
| OtherFirstName: | CARLENE | ||||||||
| OtherMiddleName: | BETTY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3970 W DURHAM RD | ||||||||
| Address2: | |||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185343358 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 513 SE QUAPAW | ||||||||
| Address2: | GRAND LAKE MENTAL HEALTH CENTER | ||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183378080 | ||||||||
| FaxNumber: | 9183378099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2732 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.