Provider Demographics
NPI:1154978807
Name:ZELLNER, ZACHARY (LPC, SAC-IT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:ZELLNER
Suffix:
Gender:M
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 N CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3431
Mailing Address - Country:US
Mailing Address - Phone:920-224-2056
Mailing Address - Fax:
Practice Address - Street 1:1234 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1307
Practice Address - Country:US
Practice Address - Phone:920-224-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10820-125101YM0800X
171M00000X
WI10820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator