Provider Demographics
NPI:1295722965
Name:ZAKARAS, MICHAEL E (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:ZAKARAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:E
Other - Last Name:ZAKARAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 2341
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39505-2341
Mailing Address - Country:US
Mailing Address - Phone:228-832-5041
Mailing Address - Fax:228-832-5820
Practice Address - Street 1:15465 OAK LN
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2663
Practice Address - Country:US
Practice Address - Phone:228-832-5041
Practice Address - Fax:228-832-5820
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical