Provider Demographics
NPI:1699355412
Name:PACHOL, ZACHARY SCOTT
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:SCOTT
Last Name:PACHOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5462
Mailing Address - Country:US
Mailing Address - Phone:815-302-0307
Mailing Address - Fax:
Practice Address - Street 1:6200 AURORA AVE STE 305E
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2863
Practice Address - Country:US
Practice Address - Phone:515-724-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health