Basic Information
Provider Information
NPI: 1720638315
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZACHRICH
FirstName: CYNTHIA
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 885 COMMERCE DR
Address2:  
City: PERRYSBURG
State: OH
PostalCode: 435515267
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1624 TIFFIN AVE STE D
Address2:  
City: FINDLAY
State: OH
PostalCode: 458406852
CountryCode: US
TelephoneNumber: 4194227800
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2019
LastUpdateDate: 09/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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