Provider Demographics
NPI:1730847526
Name:KHELAH, ZACHARY KHALIL (LPCIT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KHALIL
Last Name:KHELAH
Suffix:
Gender:M
Credentials:LPCIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N 1ST ST STE 5000
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4727
Mailing Address - Country:US
Mailing Address - Phone:715-675-3458
Mailing Address - Fax:
Practice Address - Street 1:731 N 1ST ST STE 5000
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4727
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17155101YP2500X
WI7736-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA17155OtherLICENSE