Healthcare Provider Details

I. General information

NPI: 1770734196
Provider Name (Legal Business Name): COLLEEN L ZURCHER MCGAURAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 CONSTITUTION DR D
FORT WAYNE IN
46804-1583
US

IV. Provider business mailing address

6202 CONSTITUTION DR D
FORT WAYNE IN
46804-1583
US

V. Phone/Fax

Practice location:
  • Phone: 260-423-0066
  • Fax: 888-284-8315
Mailing address:
  • Phone: 260-423-0066
  • Fax: 888-284-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001685A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH0001800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: