Healthcare Provider Details

I. General information

NPI: 1932564697
Provider Name (Legal Business Name): JOB ELLIOTT L.P.C ;L.I.A.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 S ALMA SCHOOL RD STE 105
MESA AZ
85210-4013
US

IV. Provider business mailing address

PO BOX 11533
CHANDLER AZ
85248-0009
US

V. Phone/Fax

Practice location:
  • Phone: 480-233-5511
  • Fax:
Mailing address:
  • Phone: 480-233-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17557
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-15368
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-15039
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: