Healthcare Provider Details

I. General information

NPI: 1881337624
Provider Name (Legal Business Name): SAMANTHA MARILYN ZOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 MILL ST STE 100
RENO NV
89502-1463
US

IV. Provider business mailing address

5200 SUMMIT RIDGE DR APT 8621
RENO NV
89523-9079
US

V. Phone/Fax

Practice location:
  • Phone: 775-538-6700
  • Fax: 775-688-5878
Mailing address:
  • Phone: 916-221-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: