Healthcare Provider Details

I. General information

NPI: 1356691661
Provider Name (Legal Business Name): ZACHARY THOMAS GLEASON DBH, LMHC, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 E GRAVES AVE STE E
ORANGE CITY FL
32763-5266
US

IV. Provider business mailing address

366 E GRAVES AVE STE E
ORANGE CITY FL
32763-5266
US

V. Phone/Fax

Practice location:
  • Phone: 407-505-8705
  • Fax:
Mailing address:
  • Phone: 407-730-3837
  • Fax: 407-730-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH-14342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-23942
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: