Healthcare Provider Details

I. General information

NPI: 1992840482
Provider Name (Legal Business Name): ELANA PAYTON EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 470
PHOENIX AZ
85013-3475
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 470
PHOENIX AZ
85013-3475
US

V. Phone/Fax

Practice location:
  • Phone: 602-842-3131
  • Fax:
Mailing address:
  • Phone: 602-842-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number092126
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3738973
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: