Provider Demographics
NPI:1689206138
Name:ZELLER, JAYSON ALLEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:ALLEN
Last Name:ZELLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JAYSON
Other - Middle Name:ALLEN
Other - Last Name:ZELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4704 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-8388
Mailing Address - Country:US
Mailing Address - Phone:307-689-0218
Mailing Address - Fax:
Practice Address - Street 1:1800 W 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-9109
Practice Address - Country:US
Practice Address - Phone:307-682-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional