Zakery R Warren, LCPC4472

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

4472 Issued in ID

Practice address

2705 E 17TH St Ste a
Ammon, ID 83406-6601

Phone

(208) 346-7500

Fax

(208) 346-7501

NPI assigned

Jan 16, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pearl Health ClinicGroup PAC ID 0840356077, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pearl Health Clinic

  • Mental Health Counselor
  • Ammon, ID
  • NPI 1447426465
  Medicare reassignment Care Compare group NPD Authorized official
• Pearl Primary Care PLLC

  • Family Medicine Physician
  • Ammon, ID
  • NPI 1720561103
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1053597344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 E 17TH ST",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066601",
            "telephone_number": "208-346-7500",
            "fax_number": "208-346-7501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E 17TH ST STE A",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834066601",
            "telephone_number": "208-346-7500",
            "fax_number": "208-346-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "ZAKERY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "LCPC4472",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-16",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ID",
            "license": "4472",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LPC3960",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002648300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co (Walgreens #10603)
• Heike Wallin, FNP
• Walmart Inc. (Walmart Pharmacy 10-1902)
• Cristy Walstad, LSW
• Kelceymarie Ward, M.ED.
• Colin Waters
• Cecilia Ann Watson, RD
• Lucas Watson
• Christopher Watts, BA
• Bruce Webb, PHARMD

• Mental Health Counselor in Ammon, ID
• Providers in Ammon, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.