Provider Demographics
NPI:1356840151
Name:ZAGOURIS, ANDONI (MA)
Entity type:Individual
Prefix:MR
First Name:ANDONI
Middle Name:
Last Name:ZAGOURIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78639
Mailing Address - Country:US
Mailing Address - Phone:956-369-2995
Mailing Address - Fax:
Practice Address - Street 1:221 TARRINGTON LN
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:TX
Practice Address - Zip Code:78639-7863
Practice Address - Country:US
Practice Address - Phone:956-369-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist