Healthcare Provider Details

I. General information

NPI: 1619489267
Provider Name (Legal Business Name): ZACHARY C. ZUGIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 UNIVERSITY AVE
MADISON WI
53705-3644
US

IV. Provider business mailing address

ZACHARY ZUGIN 600 HIGHLAND AVE
MADISON WI
53705
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-9339
  • Fax:
Mailing address:
  • Phone: 608-265-6347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5391-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5391-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: