Basic Information
| Provider Information | |||||||||
| NPI: | 1568029924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORA | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LADC/MH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10707 BROADWAY EXT | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731146212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059467337 | ||||||||
| FaxNumber: | 4052424487 | ||||||||
| Practice Location | |||||||||
| Address1: | 10707 BROADWAY EXT | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731146212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059467337 | ||||||||
| FaxNumber: | 4052424487 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2019 | ||||||||
| LastUpdateDate: | 05/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 1359 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.