Active NPI
Mallory Grace Zelaya, LPCC
- Professional Counselor
- Van Nuys, CA
National Provider Identifier
1205493301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10528
- Practice address
- 14600 Sherman Way Ste 100D
Van Nuys, CA 91405-2283 - Phone
- (818) 374-6901
- NPI assigned
- May 23, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5636 | CA | |
| Professional Counselor | 101YP2500X | 10528 | CA | Primary |
Addresses
Primary practice location
14600 Sherman Way Ste 100D
Van Nuys, CA 91405-2283
Mailing address
14600 Sherman Way Ste 100D
Van Nuys, CA 91405-2283
Phone (818) 374-6901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5636 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634688000000",
"number": "1205493301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14600 SHERMAN WAY STE 100D",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914052283",
"telephone_number": "818-374-6901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14600 SHERMAN WAY STE 100D",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914052283",
"telephone_number": "818-374-6901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZELAYA",
"first_name": "MALLORY",
"middle_name": "GRACE",
"name_prefix": "Ms.",
"credential": "LPCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-23",
"last_updated": "2021-10-20",
"certification_date": "2021-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "5636",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "10528",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.