Provider Demographics
NPI:1649562513
Name:VERRETT, ZELDA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:ZELDA
Middle Name:MARIE
Last Name:VERRETT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 E COOLEY DR STE 207
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3907
Mailing Address - Country:US
Mailing Address - Phone:909-533-4585
Mailing Address - Fax:909-533-4590
Practice Address - Street 1:1003 E COOLEY DR STE 207
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3907
Practice Address - Country:US
Practice Address - Phone:909-533-4585
Practice Address - Fax:909-533-4590
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100143847Medicaid