Healthcare Provider Details

I. General information

NPI: 1073284485
Provider Name (Legal Business Name): DANIEL ZACARIAS MESSITER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 9TH ST SW STE A211
PUYALLUP WA
98373-5946
US

IV. Provider business mailing address

35 18TH ST
CAYUCOS CA
93430-1401
US

V. Phone/Fax

Practice location:
  • Phone: 800-273-8255
  • Fax:
Mailing address:
  • Phone: 831-345-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61202720
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT126893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: