Healthcare Provider Details

I. General information

NPI: 1144609819
Provider Name (Legal Business Name): MR. ZACHARY HEDGES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 04/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

500 COHASSET RD SUITE 15
CHICO CA
95926-2260
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1000
  • Fax:
Mailing address:
  • Phone: 530-891-2945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number101267
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: