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General NPI Number Information
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NPI Number | 1821510611
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Entity Type | Individual
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Provider Name | ALEXANDRIA WYETH ZETTLER ATR-BC, CTT, LMHC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 522 E PARK AVE STE 200
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City | TALLAHASSEE
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State | FL
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Zip | 32301-2583
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Country | US
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Telephone | 850-391-9891
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Fax | 850-765-5120
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Provider Business Mailing Address
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Address Line | 4000 COLLETON CT
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City | TALLAHASSEE
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State | FL
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Zip | 32311-3640
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Country | US
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Telephone | 850-391-9891
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Fax | 850-765-5120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC15771
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License Number State | FL
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