Basic Information
Provider Information
NPI: 1295158079
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZOELLER
FirstName: CAITLYN
MiddleName: MARIE
NamePrefix: MRS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: HICKS
OtherFirstName: CAITLYN
OtherMiddleName: MARIE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: LPC
OtherLastNameType: 1
Mailing Information
Address1: 1100 SHAWNEE RD
Address2:  
City: LIMA
State: OH
PostalCode: 458053583
CountryCode: US
TelephoneNumber: 4199992010
FaxNumber: 4199996284
Practice Location
Address1: 1021 W POE RD
Address2:  
City: BOWLING GREEN
State: OH
PostalCode: 434029362
CountryCode: US
TelephoneNumber: 4193524694
FaxNumber: 4193531807
Other Information
ProviderEnumerationDate: 01/29/2014
LastUpdateDate: 06/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XC.1300419-TRNEOHY Behavioral Health & Social Service ProvidersCounselorMental Health

ID Information
IDTypeStateIssuerDescription
029059905OH MEDICAID


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