MEDICARE: MR. DANIEL BEJAR LISAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC-1083	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629256433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL BEJAR LISAC

Provider Business Mailing Address
First Line	:	8200 E JACQUE DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-6172
Country	:	US
Telephone Number	:	928-713-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 E JACQUE DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-6172
Country	:	US
Telephone Number	:	928-713-6328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	01/11/2017

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