Healthcare Provider Details

I. General information

NPI: 1407279417
Provider Name (Legal Business Name): ZACKARY T PAUSTIAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR SUITE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

1400 E. SOUTHERN AVE STE. 735
TEMPE AZ
85282-2692
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-804-0083
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC- 14483
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-17293
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: