Healthcare Provider Details

I. General information

NPI: 1265783054
Provider Name (Legal Business Name): SUSAN ZINN LPCC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 WILSHIRE BLVD SUITE 310
SANTA MONICA CA
90401-1421
US

IV. Provider business mailing address

530 WILSHIRE BLVD SUITE 310
SANTA MONICA CA
90401-1421
US

V. Phone/Fax

Practice location:
  • Phone: 424-322-0140
  • Fax: 805-377-1856
Mailing address:
  • Phone: 424-322-0140
  • Fax: 805-377-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC 2850
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC 006889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: