Healthcare Provider Details

I. General information

NPI: 1285182048
Provider Name (Legal Business Name): ZACHARY J LEPARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 JUNIPER AVE
MORRO BAY CA
93442-1786
US

IV. Provider business mailing address

2690 JUNIPER AVE.
MORRO BAY CA
93442
US

V. Phone/Fax

Practice location:
  • Phone: 406-431-8114
  • Fax:
Mailing address:
  • Phone: 805-461-8103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: