MEDICARE: ZACHARY SAM APPENZELLER PSY.D.

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	39769	TX

General Provider Information

NPI Number	:	1821774472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY SAM APPENZELLER PSY.D.

Provider Business Mailing Address
First Line	:	1941 EAST RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-6010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 H. MARK CROSSWELL JR ST.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021
Country	:	US
Telephone Number	:	713-500-1500
Fax Number	:	713-500-2714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	06/27/2023

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