Provider Demographics
NPI:1932118015
Name:ZENTNER, MARK ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:ZENTNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W DEAN KEETON ST FL 5
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1091
Mailing Address - Country:US
Mailing Address - Phone:512-475-6922
Mailing Address - Fax:
Practice Address - Street 1:100 W DEAN KEETON ST FL 5
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1091
Practice Address - Country:US
Practice Address - Phone:512-475-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31574103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX59HVOtherBCBS PROVIDER NUMBER