Healthcare Provider Details

I. General information

NPI: 1144751108
Provider Name (Legal Business Name): SIMONE ZESCHUK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28752 BOLANOS
MISSION VIEJO CA
92692-1055
US

IV. Provider business mailing address

28752 BOLANOS
MISSION VIEJO CA
92692-1055
US

V. Phone/Fax

Practice location:
  • Phone: 512-698-0437
  • Fax:
Mailing address:
  • Phone: 512-698-0437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145641
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number202929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: