Healthcare Provider Details

I. General information

NPI: 1194949495
Provider Name (Legal Business Name): GEORGE ZAKY PSY.D., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 NW PRIMA VISTA BLVD
PORT SAINT LUCIE FL
34983-8731
US

IV. Provider business mailing address

447 NW PRIMA VISTA BLVD
PORT SAINT LUCIE FL
34983-8731
US

V. Phone/Fax

Practice location:
  • Phone: 772-249-2593
  • Fax:
Mailing address:
  • Phone: 772-249-2593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9083
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY8016
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8016
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY8016
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8016
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY8016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: