Healthcare Provider Details

I. General information

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

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

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
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

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

V. Phone/Fax

Practice location:
  • Phone: 417-216-7501
  • Fax:
Mailing address:
  • Phone: 918-282-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2089
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22645
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: