Provider Demographics
NPI:1104795749
Name:ZELAYA, GENESIS S
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:S
Last Name:ZELAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2039 ESTRADA PKWY APT 166
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-8237
Mailing Address - Country:US
Mailing Address - Phone:469-503-7910
Mailing Address - Fax:
Practice Address - Street 1:2039 ESTRADA PKWY APT 166
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-8237
Practice Address - Country:US
Practice Address - Phone:469-503-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor