Healthcare Provider Details

I. General information

NPI: 1265003784
Provider Name (Legal Business Name): ZACHARY SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 W UNIVERSITY AVE STE 200
LAFAYETTE LA
70506-3500
US

IV. Provider business mailing address

100 WINCHESTER DR APT 308
LAFAYETTE LA
70506-8403
US

V. Phone/Fax

Practice location:
  • Phone: 337-781-9742
  • Fax:
Mailing address:
  • Phone: 985-232-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC9977
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: