Healthcare Provider Details

I. General information

NPI: 1902229222
Provider Name (Legal Business Name): KELLE ZEABART LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLE BECKHAM LCSW

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MCKENZIE RD STE F
GREENFIELD IN
46140
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-6200
  • Fax:
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006888A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: