Provider Demographics
NPI:1912789165
Name:ZANDSTRA, ELIZABETH MATTOX (CMHC INTERN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MATTOX
Last Name:ZANDSTRA
Suffix:
Gender:F
Credentials:CMHC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 TOPSHAM CORINTH RD
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:VT
Mailing Address - Zip Code:05076-3029
Mailing Address - Country:US
Mailing Address - Phone:802-945-9009
Mailing Address - Fax:
Practice Address - Street 1:437 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-9196
Practice Address - Country:US
Practice Address - Phone:802-222-9317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health