Provider Demographics
NPI:1992574107
Name:ZVACEK, NICO MACKENZEE (T-LMFT)
Entity type:Individual
Prefix:
First Name:NICO
Middle Name:MACKENZEE
Last Name:ZVACEK
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 DINA CT STE A
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-4706
Mailing Address - Country:US
Mailing Address - Phone:319-208-2150
Mailing Address - Fax:319-774-0348
Practice Address - Street 1:1214 DINA CT STE A
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-4706
Practice Address - Country:US
Practice Address - Phone:319-208-2150
Practice Address - Fax:319-774-0348
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist