Provider Demographics
NPI:1790181865
Name:ZELLO, JOSHUA M (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:ZELLO
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2224
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-2224
Mailing Address - Country:US
Mailing Address - Phone:423-310-8206
Mailing Address - Fax:
Practice Address - Street 1:225 2ND ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311
Practice Address - Country:US
Practice Address - Phone:423-310-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003039101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health