Provider Demographics
NPI:1043254345
Name:ZAKARAS, PATSY H (PHD)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:H
Last Name:ZAKARAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PATSY
Other - Middle Name:JEAN
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2341
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-2341
Mailing Address - Country:US
Mailing Address - Phone:228-832-5041
Mailing Address - Fax:
Practice Address - Street 1:15465 OAK LN
Practice Address - Street 2:STE. D.
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2663
Practice Address - Country:US
Practice Address - Phone:228-832-5041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19-209103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS620000003-62Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.