Provider Demographics
NPI:1184208944
Name:ZELLNER, TANYA WATTS (LPC)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:WATTS
Last Name:ZELLNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 GREENE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-6014
Mailing Address - Country:US
Mailing Address - Phone:147-897-3007
Mailing Address - Fax:
Practice Address - Street 1:486 GREENE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-6014
Practice Address - Country:US
Practice Address - Phone:478-221-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008798101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional