Provider Demographics
NPI:1225440902
Name:ZACKS, KATH;EEN MARIE
Entity Type:Individual
Prefix:
First Name:KATH;EEN
Middle Name:MARIE
Last Name:ZACKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N RAINBOW BLVD APT 1128
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4552
Mailing Address - Country:US
Mailing Address - Phone:702-771-6332
Mailing Address - Fax:
Practice Address - Street 1:2901 N RAINBOW BLVD APT 1128
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4552
Practice Address - Country:US
Practice Address - Phone:702-771-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health