Provider Demographics
NPI:1346614872
Name:ZACAPA-REYES, ELSA PAULINA (LCPC)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:PAULINA
Last Name:ZACAPA-REYES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-0477
Mailing Address - Country:US
Mailing Address - Phone:620-275-0644
Mailing Address - Fax:
Practice Address - Street 1:506 AVENUE L
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-5319
Practice Address - Country:US
Practice Address - Phone:620-227-8566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2790101YP2500X
KS03076101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional