Zachary Paul Boberg, LAC THERAPIST

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LAC-22820 Issued in AZ

Practice address

3303 E Baseline Rd Ste 109
Gilbert, AZ 85234-2739

Phone

(480) 278-5290

NPI assigned

Jun 4, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Cornerstone Healing Center, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Scottsdale, AZ
  • NPI 1154823680
  NPD (past)
• Cornerstone Healing Center, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Phoenix, AZ
  • NPI 1649958760
  NPD (past)
• Cornerstone Healing Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Scottsdale, AZ
  • NPI 1710556808
  NPD (past)

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1407697295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3303 E BASELINE RD STE 109",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342739",
            "telephone_number": "480-278-5290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 E BASELINE RD STE 109",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342739",
            "telephone_number": "480-278-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOBERG",
        "first_name": "ZACHARY",
        "middle_name": "PAUL",
        "credential": "LAC THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LAC-22820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BNB, LLC
• David Boakye Danquah
• Mikayla Boatman
• Dan Boatwright, PHARMD.
• Maegan M Bobb
• Laura Jean Boche
• Joshua Frederick Bock, D.C.
• Erica Michelle Bodie, AUD
• Nathan E Bodily, M.D.
• Annabelle Bodry-Barnhart

• All providers in Gilbert, AZ
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.