Provider Demographics
NPI:1609973320
Name:ZELIG, MARK (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ZELIG
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 HIGHLAND DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4260
Mailing Address - Country:US
Mailing Address - Phone:801-273-3365
Mailing Address - Fax:866-610-1515
Practice Address - Street 1:3760 HIGHLAND DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4260
Practice Address - Country:US
Practice Address - Phone:801-273-3365
Practice Address - Fax:866-610-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00486-2501-5103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist