MEDICARE: DR. WAGANESH A ZELEKE ED.D, LCPC, NCC

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	PC009238	PA
2	101YM0800X	Mental Health Counselor	PC009238	PA

General Provider Information

NPI Number	:	1720506470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAGANESH A ZELEKE ED.D, LCPC, NCC

Provider Business Mailing Address
First Line	:	4311 GRANDVIEW DR
Second Line	:
City	:	GIBSONIA
State	:	PA
Zip	:	15044-5315
Country	:	US
Telephone Number	:	406-274-2671
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 FIFTH AVE
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6302
Country	:	US
Telephone Number	:	412-756-3344
Fax Number	:

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	02/21/2021

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