Provider Demographics
NPI:1851503049
Name:ZITZMAN, SPENCER TODD (PHD, LMFT-S)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:TODD
Last Name:ZITZMAN
Suffix:
Gender:M
Credentials:PHD, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 JOHN ADAMS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4300
Mailing Address - Country:US
Mailing Address - Phone:208-529-5276
Mailing Address - Fax:208-529-6506
Practice Address - Street 1:1600 JOHN ADAMS PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4300
Practice Address - Country:US
Practice Address - Phone:208-529-5276
Practice Address - Fax:208-529-6506
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0600002106H00000X
IDLMFT-4766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist