Provider Demographics
NPI:1295082592
Name:WITTMANN, ZACHARY SEAN (LCPC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:SEAN
Last Name:WITTMANN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1622
Mailing Address - Country:US
Mailing Address - Phone:618-334-8441
Mailing Address - Fax:
Practice Address - Street 1:29 HARVEST CT
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1622
Practice Address - Country:US
Practice Address - Phone:618-334-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009322101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor