Provider Demographics
NPI:1427497072
Name:ZELLERS, DANIELLE (LCPC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:ZELLERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23314 INDIAN POINT AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-7049
Mailing Address - Country:US
Mailing Address - Phone:217-416-6504
Mailing Address - Fax:
Practice Address - Street 1:109 E LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-2604
Practice Address - Country:US
Practice Address - Phone:217-528-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001763101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor