Provider Demographics
NPI:1124157045
Name:ZUTELL, JOSEPHINE
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:
Last Name:ZUTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JO
Other - Middle Name:
Other - Last Name:ZUTELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8660 LIVE OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305
Mailing Address - Country:US
Mailing Address - Phone:928-778-1414
Mailing Address - Fax:
Practice Address - Street 1:8766 EAST HWY 69
Practice Address - Street 2:HUMBOLDT UNIFIED SCHOOL DISTRICT # 22 SPECIAL SERVICES
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4028
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLFMFT0131101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ777708Medicaid