Healthcare Provider Details

I. General information

NPI: 1972379469
Provider Name (Legal Business Name): RHONDA NELSON ZAVALA LPC ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CREIGHTON AVE
RED OAK TX
75154-1460
US

IV. Provider business mailing address

316 CREIGHTON AVE
RED OAK TX
75154-1460
US

V. Phone/Fax

Practice location:
  • Phone: 817-714-8406
  • Fax:
Mailing address:
  • Phone: 817-714-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number59150
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number891113
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number89113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: