Basic Information
Provider Information
NPI: 1811659964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DISPIRITO
FirstName: ZACHARY
MiddleName: THOMAS
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 530 S MAIN ST
Address2:  
City: LIMA
State: OH
PostalCode: 458041500
CountryCode: US
TelephoneNumber: 5673714418
FaxNumber:  
Practice Location
Address1: 2515 N MAIN ST
Address2:  
City: FINDLAY
State: OH
PostalCode: 458403972
CountryCode: US
TelephoneNumber: 4194255050
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/06/2021
LastUpdateDate: 10/06/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/06/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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