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NPI Code Detail

MEDICARE: JANEL WITHERSPOON LPC

MEDICARE: JANEL WITHERSPOON LPC
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
1101YP2500XProfessional CounselorLPC-17633AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LPC-17633OTHERAZPROFESSIONAL COUNSELING LICENSE

General Provider Information

NPI Number : 1659838845
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANEL WITHERSPOON LPC
Provider Business Mailing Address
First Line : 20118 N 67TH AVE STE 300-315
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-4621
Country : US
Telephone Number : 623-688-9158
Fax Number :
Provider Business Practice Location Address
First Line : 34975 N NORTH VALLEY PKWY STE 152
Second Line :
City : PHOENIX
State : AZ
Zip : 85086-4032
Country : US
Telephone Number : 623-688-9158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 07/05/2019

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