MEDICARE: DR. YOLY ZENTELLA PH.D, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0086021	NM

General Provider Information

NPI Number	:	1932263647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOLY ZENTELLA PH.D, LPCC

Provider Business Mailing Address
First Line	:	PO BOX 1551
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-1551
Country	:	US
Telephone Number	:	505-718-5924
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 NATIONAL AVE
Second Line	:	APT 2
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4277
Country	:	US
Telephone Number	:	505-718-5924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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