Provider Demographics
NPI:1477392314
Name:ZEN ARK BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:ZEN ARK BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:OCHUWA
Authorized Official - Last Name:WALTER-ETOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-314-5467
Mailing Address - Street 1:12030 BANDERA RD STE 108
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4736
Mailing Address - Country:US
Mailing Address - Phone:210-314-5467
Mailing Address - Fax:
Practice Address - Street 1:12030 BANDERA RD STE 108
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4736
Practice Address - Country:US
Practice Address - Phone:210-314-5467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty