MEDICARE: RHONDA NELSON ZAVALA LPC ASSOCIATE

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	59150	TX
2	101YP2500X	Professional Counselor	891113	TX
3	101YM0800X	Mental Health Counselor	89113	TX

General Provider Information

NPI Number	:	1972379469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA NELSON ZAVALA LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	316 CREIGHTON AVE
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-1460
Country	:	US
Telephone Number	:	817-714-8406
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 CREIGHTON AVE
Second Line	:
City	:	RED OAK
State	:	TX
Zip	:	75154-1460
Country	:	US
Telephone Number	:	817-714-8406
Fax Number	:

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

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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