Healthcare Provider Details

I. General information

NPI: 1801727748
Provider Name (Legal Business Name): HEIDI ZELLER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 S 45TH ST
BOULDER CO
80305-6046
US

IV. Provider business mailing address

370 S 45TH ST
BOULDER CO
80305-6046
US

V. Phone/Fax

Practice location:
  • Phone: 309-657-1909
  • Fax:
Mailing address:
  • Phone: 309-657-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0011753
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: