MEDICARE: ZACHARY PSYCHOLOGY CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	605	LA

General Provider Information

NPI Number	:	1538229836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACHARY PSYCHOLOGY CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 86
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-0086
Country	:	US
Telephone Number	:	225-654-2357
Fax Number	:	225-654-1192

Provider Business Practice Location Address
First Line	:	4863A MAIN ST
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-3943
Country	:	US
Telephone Number	:	225-654-2357
Fax Number	:	225-654-1192

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. PEGGY C. SMITH
Credential	:	PH.D.
Telephone Number	:	225-654-2357

Provider Enumeration Date	:	12/10/2006
Last Update Date	:	08/22/2020

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