Healthcare Provider Details

I. General information

NPI: 1144042755
Provider Name (Legal Business Name): ZACHERY O HURD TLLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 10/26/2024
Certification Date: 10/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29750 HARPER AVE
SAINT CLAIR SHORES MI
48082-2607
US

IV. Provider business mailing address

29750 HARPER AVE
SAINT CLAIR SHORES MI
48082-2607
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-3200
  • Fax: 586-777-7855
Mailing address:
  • Phone: 248-755-3814
  • Fax: 586-777-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010056
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: