Provider Demographics
NPI:1477098267
Name:ZONDLO, LUZ (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:
Last Name:ZONDLO
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 1:320 HARBOR BLVD
Mailing Address - Street 2:UNIT 302
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541
Mailing Address - Country:US
Mailing Address - Phone:850-654-5447
Mailing Address - Fax:
Practice Address - Street 1:3686 US HIGHWAY 331S
Practice Address - Street 2:CHAUTAUQUA OFFICES OF PSYCHOTHERAPY & EVALUATION
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435
Practice Address - Country:US
Practice Address - Phone:850-892-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health