Provider Demographics
NPI:1578916201
Name:DEVORE, ZACHARY RYAN (LPC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RYAN
Last Name:DEVORE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5261
Mailing Address - Country:US
Mailing Address - Phone:815-773-0772
Mailing Address - Fax:815-773-0771
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5261
Practice Address - Country:US
Practice Address - Phone:815-773-0772
Practice Address - Fax:815-773-0771
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional