Provider Demographics
NPI:1083162077
Name:ZELENKA, NIKKI L (MS, LCPC, NCC)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:L
Last Name:ZELENKA
Suffix:
Gender:F
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 W GRIFFIN DR STE A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2552
Mailing Address - Country:US
Mailing Address - Phone:347-840-1157
Mailing Address - Fax:
Practice Address - Street 1:618 W GRIFFIN DR STE A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2552
Practice Address - Country:US
Practice Address - Phone:347-840-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional