Provider Demographics
NPI:1932816360
Name:AVERY, ZACHARY HAMILTON (LMSW, LMT, TIYT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:HAMILTON
Last Name:AVERY
Suffix:
Gender:M
Credentials:LMSW, LMT, TIYT
Other - Prefix:
Other - First Name:Z
Other - Middle Name:HAMILTON
Other - Last Name:AVERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7335 S UTICA AVE APT 1102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7329
Mailing Address - Country:US
Mailing Address - Phone:918-282-7847
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1075
Practice Address - Country:US
Practice Address - Phone:918-268-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK202241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator