Healthcare Provider Details

I. General information

NPI: 1619938875
Provider Name (Legal Business Name): JASON F ZOELLERS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 NE WINDSOR DR
LEES SUMMIT MO
64086
US

IV. Provider business mailing address

1272 NE WINDSOR DR
LEES SUMMIT MO
64086-5594
US

V. Phone/Fax

Practice location:
  • Phone: 816-246-4465
  • Fax: 816-524-7008
Mailing address:
  • Phone: 816-246-4465
  • Fax: 816-524-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018034138
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: