Healthcare Provider Details

I. General information

NPI: 1417204314
Provider Name (Legal Business Name): LOURDES ZAPATA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 S PERIMETER RD SUITE 120
FORT LAUDERDALE FL
33309-7122
US

IV. Provider business mailing address

1925 S PERIMETER RD SUITE 120
FORT LAUDERDALE FL
33309-7122
US

V. Phone/Fax

Practice location:
  • Phone: 954-958-0988
  • Fax: 954-958-3527
Mailing address:
  • Phone: 954-958-0988
  • Fax: 954-958-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: