Healthcare Provider Details

I. General information

NPI: 1659947554
Provider Name (Legal Business Name): RUI ZELLER CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

563 W 500 S STE 230
BOUNTIFUL UT
84010-8290
US

IV. Provider business mailing address

563 W 500 S STE 230
BOUNTIFUL UT
84010-8290
US

V. Phone/Fax

Practice location:
  • Phone: 385-503-5646
  • Fax:
Mailing address:
  • Phone: 385-503-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13403087-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: