Provider Demographics
NPI:1639788664
Name:GURAM, ZACHARY (LPC)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:GURAM
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 1:3503 CURTIS ST # A
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2209
Mailing Address - Country:US
Mailing Address - Phone:682-209-3302
Mailing Address - Fax:
Practice Address - Street 1:3503 CURTIS ST # A
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2209
Practice Address - Country:US
Practice Address - Phone:682-209-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional