Healthcare Provider Details

I. General information

NPI: 1548347321
Provider Name (Legal Business Name): SHEILA MARIE BABENDIR EDD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 W FOREST MEADOWS ST STE 140
FLAGSTAFF AZ
86001-7226
US

IV. Provider business mailing address

1338 W FOREST MEADOWS ST STE 140
FLAGSTAFF AZ
86001-7226
US

V. Phone/Fax

Practice location:
  • Phone: 928-212-8621
  • Fax: 480-282-8365
Mailing address:
  • Phone: 928-212-8621
  • Fax: 928-326-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberLPC-10664
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10664
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: