Healthcare Provider Details

I. General information

NPI: 1407222045
Provider Name (Legal Business Name): JASON JEFFRIES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 N 83RD AVE STE 170
PEORIA AZ
85381-5646
US

IV. Provider business mailing address

14050 N 83RD AVE STE 170
PEORIA AZ
85381-5646
US

V. Phone/Fax

Practice location:
  • Phone: 623-398-8854
  • Fax:
Mailing address:
  • Phone: 623-398-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17683
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: