Individual
MR. KENNETH JAY ZUMBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LMHC
Contact information
Practice address
655 E MAIN ST, PERU, IN 46970-2662
(765) 472-1931
(765) 472-1945
Mailing address
1015 MICHIGAN AVE, LOGANSPORT, IN 46947-1526
(574) 722-5151
(574) 739-1414
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
39000953A
IN
101YM0800X
Mental Health Counselor
Primary
39000953A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000185891
ANTHEM
IN
Enumeration date
06/29/2006
Last updated
04/10/2008
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