Healthcare Provider Details

I. General information

NPI: 1104770593
Provider Name (Legal Business Name): STEPHANIE ANN NELLOR ZOELLER LMHCA MC70074411
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 SE 192ND AVE STE 265
CAMAS WA
98607-7475
US

IV. Provider business mailing address

2005 SE 192ND AVE STE 265
CAMAS WA
98607-7475
US

V. Phone/Fax

Practice location:
  • Phone: 360-356-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC70074411
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: