| Gzw Psych Pllc | |
|
2375 University Ave W Ste 160 Saint Paul MN 55114-1632 | |
| (612) 643-3479 | |
| (612) 643-3479 |
| Full Name | Gzw Psych Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 2375 University Ave W Ste 160, Saint Paul, Minnesota |
| Authorized Official Name and Position | G Zachariah White (OWNER) |
| Authorized Official Contact | 6122089739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gzw Psych Pllc 2375 University Ave W Ste 160 Saint Paul MN 55114-1632 Ph: (612) 643-3479 | Gzw Psych Pllc 2375 University Ave W Ste 160 Saint Paul MN 55114-1632 Ph: (612) 643-3479 |
| NPI Number | 1558834267 |
|---|---|
| Provider Enumeration Date | 01/04/2019 |
| Last Update Date | 12/09/2023 |
| Certification Date | 12/09/2023 |
| Medicare PECOS PAC ID | 4385092477 |
|---|---|
| Medicare Enrollment ID | O20231130000506 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558834267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | G Zachariah White |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790012771 PECOS PAC ID: 4789726027 Enrollment ID: I20231130000559 |
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