Provider Demographics
NPI:1366049124
Name:NIELSEN, ZACHERY (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ZACHERY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 UTICA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1616
Mailing Address - Country:US
Mailing Address - Phone:563-265-5063
Mailing Address - Fax:877-583-4958
Practice Address - Street 1:3350 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3509
Practice Address - Country:US
Practice Address - Phone:563-265-5063
Practice Address - Fax:877-583-4958
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA105182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health