Provider Demographics
NPI:1780282368
Name:KRUGER, ZACHARY MITCHELL (MA, NLC)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:MITCHELL
Last Name:KRUGER
Suffix:
Gender:M
Credentials:MA, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-1011
Mailing Address - Country:US
Mailing Address - Phone:720-593-4701
Mailing Address - Fax:
Practice Address - Street 1:419 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540
Practice Address - Country:US
Practice Address - Phone:720-593-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0107507101Y00000X
COLPC.0017760101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONLC.0107507OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
COLPC.0017760OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES