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General NPI Number Information
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NPI Number | 1053597344
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Entity Type | Individual
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Provider Name | ZAKERY R WARREN LCPC4472
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Gender | Male
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 2705 E 17TH ST STE A
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City | AMMON
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State | ID
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Zip | 83406-6601
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Country | US
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Telephone | 208-346-7500
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Fax | 208-346-7501
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Provider Business Mailing Address
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Address Line | 2705 E 17TH ST
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City | AMMON
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State | ID
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Zip | 83406-6601
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Country | US
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Telephone | 208-346-7500
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Fax | 208-346-7501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4472
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LPC3960
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License Number State | ID
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