Provider Demographics
NPI:1013456839
Name:ZACHARY BURNS, INC
Entity Type:Organization
Organization Name:ZACHARY BURNS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCSW
Authorized Official - Phone:219-916-2521
Mailing Address - Street 1:30 E 150 S
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9606
Mailing Address - Country:US
Mailing Address - Phone:219-916-2521
Mailing Address - Fax:219-462-4741
Practice Address - Street 1:8 MORGAN BLVD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4836
Practice Address - Country:US
Practice Address - Phone:219-916-2521
Practice Address - Fax:219-462-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007410A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty