MEDICARE: HECTOR R ZAVALA LCPC, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	180008993	IL

General Provider Information

NPI Number	:	1679852255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR R ZAVALA LCPC, LMHC

Provider Business Mailing Address
First Line	:	1803 NORWOOD DR
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-1131
Country	:	US
Telephone Number	:	630-750-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	3145 45TH ST STE A
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-3292
Country	:	US
Telephone Number	:	331-277-8585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	02/18/2024

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