Provider Demographics
NPI:1154731065
Name:ZELENAK, GLEN (MA, LMFTA)
Entity type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:ZELENAK
Suffix:
Gender:
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 BROAD RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9848
Mailing Address - Country:US
Mailing Address - Phone:336-253-3839
Mailing Address - Fax:
Practice Address - Street 1:8104 BROAD RIDGE CT
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9848
Practice Address - Country:US
Practice Address - Phone:336-253-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9069A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist