Healthcare Provider Details

I. General information

NPI: 1205319829
Provider Name (Legal Business Name): ZACHARY MCFARREN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W MAPLE ST STE 103
NORTH CANTON OH
44720-2858
US

IV. Provider business mailing address

PO BOX 611
DALTON OH
44618-0611
US

V. Phone/Fax

Practice location:
  • Phone: 330-966-8677
  • Fax:
Mailing address:
  • Phone: 330-966-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: