Healthcare Provider Details

I. General information

NPI: 1932263647
Provider Name (Legal Business Name): YOLY ZENTELLA PH.D, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 NATIONAL AVE APT 2
LAS VEGAS NM
87701-4277
US

IV. Provider business mailing address

PO BOX 1551
LAS VEGAS NM
87701-1551
US

V. Phone/Fax

Practice location:
  • Phone: 505-718-5924
  • Fax:
Mailing address:
  • Phone: 505-718-5924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0086021
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: