=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760898761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBECCA ZELENY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2014
-----------------------------------------------------
Last Update Date | 07/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 EUREKA STREET
-----------------------------------------------------
City | BERRYVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72616-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-981-0060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 HAYES AVE
-----------------------------------------------------
City | EUREKA SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72632-9302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | REBECCA ZELENY
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 479-981-0060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 2361-C
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------