Healthcare Provider Details

I. General information

NPI: 1841997897
Provider Name (Legal Business Name): ADRIANA CAROLINA ZARATE CMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADRIANA CAROLINA GAFFEY ACMHC

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 PHEASANT RIDGE DR
CHUBBUCK ID
83202-1707
US

IV. Provider business mailing address

422 PHEASANT RIDGE DR
CHUBBUCK ID
83202-1707
US

V. Phone/Fax

Practice location:
  • Phone: 208-270-5148
  • Fax:
Mailing address:
  • Phone: 208-270-5148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12828460-6009
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4061878
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: