Provider Demographics
NPI:1891278479
Name:MCBRIEN, ZACHARY J TYLER
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J TYLER
Last Name:MCBRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 VISTA POINT CT NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2626
Mailing Address - Country:US
Mailing Address - Phone:517-896-2673
Mailing Address - Fax:
Practice Address - Street 1:2471 VISTA POINT CT NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-2626
Practice Address - Country:US
Practice Address - Phone:517-896-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician