MEDICARE: ZACHARY RYAN MORTUS

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1841993011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY RYAN MORTUS

Provider Business Mailing Address
First Line	:	200 SPRINGTOWN WAY APT 330C
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-7167
Country	:	US
Telephone Number	:	832-851-4335
Fax Number	:

Provider Business Practice Location Address
First Line	:	1099 N WALNUT AVE STE A
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-5323
Country	:	US
Telephone Number	:	830-515-8480
Fax Number	:

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

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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Directions to “ ZACHARY RYAN MORTUS ” Practice Location

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