Provider Demographics
NPI:1558834267
Name:GZW PSYCH PLLC
Entity Type:Organization
Organization Name:GZW PSYCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:ZACHARIAH
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:612-208-9739
Mailing Address - Street 1:2375 UNIVERSITY AVE W STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1632
Mailing Address - Country:US
Mailing Address - Phone:612-643-3479
Mailing Address - Fax:612-643-3479
Practice Address - Street 1:2375 UNIVERSITY AVE W STE 160
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1632
Practice Address - Country:US
Practice Address - Phone:612-643-3479
Practice Address - Fax:612-643-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty