Provider Demographics
NPI:1366012148
Name:KUSTER, ZACHARY RYAN (MDIV, MA)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:RYAN
Last Name:KUSTER
Suffix:
Gender:M
Credentials:MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TENNESSEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4208
Mailing Address - Country:US
Mailing Address - Phone:434-907-7613
Mailing Address - Fax:
Practice Address - Street 1:1701 TENNESSEE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4208
Practice Address - Country:US
Practice Address - Phone:434-907-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL713801322OtherHPSO