Healthcare Provider Details

I. General information

NPI: 1932816360
Provider Name (Legal Business Name): ZACHARY HAMILTON AVERY LCSW, BC-TMH, TIYT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: Z. HAMILTON AVERY LCSW, BC-TMH, TIYT

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W B ST FL 4
SAN DIEGO CA
92101-3537
US

IV. Provider business mailing address

5401 S HARVARD AVE # 402
TULSA OK
74135-3867
US

V. Phone/Fax

Practice location:
  • Phone: 417-216-7501
  • Fax:
Mailing address:
  • Phone: 918-212-8373
  • Fax: 539-666-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22645
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9081435
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPSW7232
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2089
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: