Healthcare Provider Details

I. General information

NPI: 1710303904
Provider Name (Legal Business Name): ZEILBECK GROUP INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 MONROE ST
LA PORTE IN
46350-3356
US

IV. Provider business mailing address

717 MONROE ST
LA PORTE IN
46350-3356
US

V. Phone/Fax

Practice location:
  • Phone: 219-575-1437
  • Fax:
Mailing address:
  • Phone: 219-575-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. ANDREW THOMAS ZEILBECK
Title or Position: CEO
Credential: MA
Phone: 219-575-1437