Provider Demographics
NPI:1285815894
Name:ZELLER, SUZANNE KAY (LMHC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KAY
Last Name:ZELLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 58TH AVE N
Mailing Address - Street 2:#6
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2063
Mailing Address - Country:US
Mailing Address - Phone:727-521-4585
Mailing Address - Fax:
Practice Address - Street 1:1921 58TH AVE N
Practice Address - Street 2:#6
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2063
Practice Address - Country:US
Practice Address - Phone:727-521-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763976700Medicaid
FLZ148HOtherBCBS OF FLORIDA