Healthcare Provider Details

I. General information

NPI: 1841859857
Provider Name (Legal Business Name): PAUL JOSEPH ZILLER MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2482 SUTTER ST
SAN FRANCISCO CA
94115-3016
US

IV. Provider business mailing address

2639 MCALLISTER ST
SAN FRANCISCO CA
94118-4112
US

V. Phone/Fax

Practice location:
  • Phone: 415-851-4884
  • Fax:
Mailing address:
  • Phone: 415-902-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: