Provider Demographics
NPI:1285907121
Name:HEATHER A ZAK PHD PC
Entity type:Organization
Organization Name:HEATHER A ZAK PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-327-7400
Mailing Address - Street 1:302 S WAVERLY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3631
Mailing Address - Country:US
Mailing Address - Phone:517-327-7400
Mailing Address - Fax:517-327-3915
Practice Address - Street 1:302 S WAVERLY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3631
Practice Address - Country:US
Practice Address - Phone:517-327-7400
Practice Address - Fax:517-327-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4398970103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty