Healthcare Provider Details

I. General information

NPI: 1346614872
Provider Name (Legal Business Name): ELSA PAULINA ZACAPA-REYES LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 AVENUE L
DODGE CITY KS
67801-5319
US

IV. Provider business mailing address

PO BOX 477
GARDEN CITY KS
67846-0477
US

V. Phone/Fax

Practice location:
  • Phone: 620-227-8566
  • Fax:
Mailing address:
  • Phone: 620-275-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2790
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03076
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: