Healthcare Provider Details

I. General information

NPI: 1861335143
Provider Name (Legal Business Name): ZACK COLLIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22880 SAVI RANCH PKWY STE B
YORBA LINDA CA
92887-4665
US

IV. Provider business mailing address

22880 SAVI RANCH PKWY STE B
YORBA LINDA CA
92887-4665
US

V. Phone/Fax

Practice location:
  • Phone: 714-243-5252
  • Fax:
Mailing address:
  • Phone: 714-243-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number138289
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: