Healthcare Provider Details

I. General information

NPI: 1376008649
Provider Name (Legal Business Name): ZACHARY ABBOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 E MORRIS AVE
MODESTO CA
95354-0437
US

IV. Provider business mailing address

8898 RODDEN RD
OAKDALE CA
95361-8777
US

V. Phone/Fax

Practice location:
  • Phone: 209-552-2807
  • Fax:
Mailing address:
  • Phone: 650-201-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: