Provider Demographics
NPI:1174755987
Name:ZEBOSKI, DWAYNE GARRETT (LPC)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:GARRETT
Last Name:ZEBOSKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 N HWY 360 APT 1017
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7895
Mailing Address - Country:US
Mailing Address - Phone:817-299-9200
Mailing Address - Fax:817-461-6203
Practice Address - Street 1:915 SKYLINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4924
Practice Address - Country:US
Practice Address - Phone:817-299-9200
Practice Address - Fax:817-461-6203
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional