Provider Demographics
NPI:1841256625
Name:ZELLER, TAMRA L (MS CPCI)
Entity type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:L
Last Name:ZELLER
Suffix:
Gender:F
Credentials:MS CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 SILVER MEADOWS DR
Mailing Address - Street 2:#4
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098
Mailing Address - Country:US
Mailing Address - Phone:801-638-0435
Mailing Address - Fax:801-268-2176
Practice Address - Street 1:3809 S WEST TEMPLE
Practice Address - Street 2:#1B
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115
Practice Address - Country:US
Practice Address - Phone:801-268-4454
Practice Address - Fax:801-268-2176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT48085136009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor