Basic Information
| Provider Information | |||||||||
| NPI: | 1669626925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIEMBA | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706410229 | ||||||||
| FaxNumber: | 9706412949 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 N TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | GUNNISON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812302244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706410229 | ||||||||
| FaxNumber: | 9706412949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2008 | ||||||||
| LastUpdateDate: | 09/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 0144061 | NM | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 1052 | CO | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.