Healthcare Provider Details

I. General information

NPI: 1194975987
Provider Name (Legal Business Name): DANIEL E BEJESKY MA, LPC, LISAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E ASPEN AVE
FLAGSTAFF AZ
86001-5259
US

IV. Provider business mailing address

3026 W MELINDA LN
PHOENIX AZ
85027-2345
US

V. Phone/Fax

Practice location:
  • Phone: 602-578-4843
  • Fax:
Mailing address:
  • Phone: 602-578-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-11841
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-12040
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: