Provider Demographics
NPI:1295158079
Name:ZOELLER, CAITLYN MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:MARIE
Last Name:ZOELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:CAITLYN
Other - Middle Name:MARIE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1100 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3583
Mailing Address - Country:US
Mailing Address - Phone:419-999-2010
Mailing Address - Fax:419-999-6284
Practice Address - Street 1:1021 W POE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9362
Practice Address - Country:US
Practice Address - Phone:419-352-4694
Practice Address - Fax:419-353-1807
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300419-TRNE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290599Medicaid