Healthcare Provider Details

I. General information

NPI: 1245318500
Provider Name (Legal Business Name): BEJARANO COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 N MASTICK WAY SUITE D
NOGALES AZ
85621-1135
US

IV. Provider business mailing address

1790 N MASTICK WAY SUITE D
NOGALES AZ
85621-1135
US

V. Phone/Fax

Practice location:
  • Phone: 520-313-3476
  • Fax: 520-377-8279
Mailing address:
  • Phone: 520-313-3476
  • Fax: 520-377-8279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK B. BEJARANO
Title or Position: COUNSELOR
Credential: LPC
Phone: 520-313-3476