Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | LFMFT0131 | AZ |
NPI | 1124157045 |
---|---|
Provider Name | Mrs. Josephine Zutell |
First Address | Prescott, AZ 86305 |
Second Address | Prescott Valley, AZ 86314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
777708 | (05) | AZ |