MEDICARE: MR. ZACHARY CONWAY LPC, SAC

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	101YM0800X	Mental Health Counselor	5047-125	WI
2	101YM0800X	Mental Health Counselor	LPC.0011637	CO

General Provider Information

NPI Number	:	1891049334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZACHARY CONWAY LPC, SAC

Provider Business Mailing Address
First Line	:	210 SLEEPY HOLLOW LN
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-3230
Country	:	US
Telephone Number	:	970-761-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 LINCOLN AVE STE 200
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-4972
Country	:	US
Telephone Number	:	970-761-9908
Fax Number	:

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

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	07/05/2022

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