Provider Demographics
NPI:1972660298
Name:ZELENSKI, PAUL (MFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ZELENSKI
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 BUENA VISTA ST STE C
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2486
Mailing Address - Country:US
Mailing Address - Phone:626-574-0200
Mailing Address - Fax:909-592-8832
Practice Address - Street 1:1227 BUENA VISTA ST STE C
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2486
Practice Address - Country:US
Practice Address - Phone:626-574-0200
Practice Address - Fax:909-592-8832
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist