Basic Information
| Provider Information | |||||||||
| NPI: | 1477098267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZONDLO | ||||||||
| FirstName: | LUZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 HARBOR BLVD | ||||||||
| Address2: | UNIT 302 | ||||||||
| City: | DESTIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506545447 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3686 US HIGHWAY 331S | ||||||||
| Address2: | CHAUTAUQUA OFFICES OF PSYCHOTHERAPY & EVALUATION | ||||||||
| City: | DEFUNIAK SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508928045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2017 | ||||||||
| LastUpdateDate: | 01/03/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MH14600 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.