Healthcare Provider Details

I. General information

NPI: 1114328036
Provider Name (Legal Business Name): ZOE LANTELME PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 FELL ST STE A
SAN FRANCISCO CA
94102-5147
US

IV. Provider business mailing address

1052 POTRERO AVE APT 4
SAN FRANCISCO CA
94110-3551
US

V. Phone/Fax

Practice location:
  • Phone: 530-739-1685
  • Fax:
Mailing address:
  • Phone: 978-902-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number31233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: