Provider Demographics
NPI:1376793083
Name:CARRELS-ZELLER, JAYNE ANNE (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:ANNE
Last Name:CARRELS-ZELLER
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1330
Mailing Address - Street 2:
Mailing Address - City:PARKSLEY
Mailing Address - State:VA
Mailing Address - Zip Code:23421-5863
Mailing Address - Country:US
Mailing Address - Phone:608-769-7281
Mailing Address - Fax:
Practice Address - Street 1:19056 GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421-5863
Practice Address - Country:US
Practice Address - Phone:608-769-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1116101YP2500X
WY438101YM0800X
VA0701004811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health