Individual
MRS. ELLEN CUSACK VIMMERSTEDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
301 E BETHANY HOME RD, C-296, PHOENIX, AZ 85012-1263
(602) 266-8442
(602) 588-9618
Mailing address
301 E BETHANY HOME RD, C-296, PHOENIX, AZ 85012-1263
(602) 266-8442
(602) 588-9618
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-1266
AZ
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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