MEDICARE: MR. ZACHARY JAMES PYNE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	PRC14888	DC
2	101YM0800X	Mental Health Counselor	PRC14888	DC

General Provider Information

NPI Number	:	1326510736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACHARY JAMES PYNE LPC

Provider Business Mailing Address
First Line	:	819 DELAWARE AVE SW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-4207
Country	:	US
Telephone Number	:	443-834-3256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1638 R ST NW STE 310
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-6446
Country	:	US
Telephone Number	:	443-281-9536
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2018
Last Update Date	:	12/23/2018

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