Healthcare Provider Details

I. General information

NPI: 1760713721
Provider Name (Legal Business Name): CECILIA GAYE ZINNIKAS L.P.C. OK#2869
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECILIA GAYE DIETZE L.P.C. OK#2869

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 3RD AVE N STE 207
BILLINGS MT
59101-1934
US

IV. Provider business mailing address

PO BOX 485
LANGLEY OK
74350-0485
US

V. Phone/Fax

Practice location:
  • Phone: 406-601-9061
  • Fax:
Mailing address:
  • Phone: 918-734-7192
  • Fax: 918-589-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number50216
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2869
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: