Provider Demographics
NPI:1902406820
Name:ZACOUR, ANASTASIA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:ZACOUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ZENITH DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6031
Mailing Address - Country:US
Mailing Address - Phone:915-494-0790
Mailing Address - Fax:
Practice Address - Street 1:10737 GATEWAY BLVD W STE 204
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4910
Practice Address - Country:US
Practice Address - Phone:915-286-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical