Healthcare Provider Details

I. General information

NPI: 1134733553
Provider Name (Legal Business Name): ZACHARY DOWNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E SUNSHINE ST STE 203
SPRINGFIELD MO
65804-1886
US

IV. Provider business mailing address

2200 E SUNSHINE ST STE 203
SPRINGFIELD MO
65804-1886
US

V. Phone/Fax

Practice location:
  • Phone: 417-861-0765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: