Healthcare Provider Details

I. General information

NPI: 1295401982
Provider Name (Legal Business Name): MARY B ZOLLMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2021
Last Update Date: 08/21/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 MICHELSON DR STE 214
IRVINE CA
92612-1212
US

IV. Provider business mailing address

430 RIVERSIDE AVE
NEWPORT BEACH CA
92663-4815
US

V. Phone/Fax

Practice location:
  • Phone: 949-891-2489
  • Fax:
Mailing address:
  • Phone: 949-887-9504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: