Healthcare Provider Details

I. General information

NPI: 1164986055
Provider Name (Legal Business Name): ZARANDONA COUNSELING AND ASSESSMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W MCKINLEY AVE STE 318
MISHAWAKA IN
46545-5651
US

IV. Provider business mailing address

310 W MCKINLEY AVE STE 318
MISHAWAKA IN
46545-5651
US

V. Phone/Fax

Practice location:
  • Phone: 574-397-3456
  • Fax: 574-607-3009
Mailing address:
  • Phone: 574-397-3456
  • Fax: 574-607-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAURA ELENA ZARANDONA
Title or Position: MENTAL HEALTH COUNSELOR
Credential: MS, LMHC
Phone: 574-206-3937