Provider Demographics
NPI:1477177053
Name:ZALANKA, RICHARD ALLEN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:ZALANKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 FITZGERALD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2620
Mailing Address - Country:US
Mailing Address - Phone:863-701-8700
Mailing Address - Fax:
Practice Address - Street 1:190 FITZGERALD RD STE 1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2620
Practice Address - Country:US
Practice Address - Phone:863-701-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-0004793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health