Healthcare Provider Details

I. General information

NPI: 1114345519
Provider Name (Legal Business Name): ELIZABETH OGREN MED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE 200
PHOENIX AZ
85016-4661
US

IV. Provider business mailing address

4539 N 22ND ST STE 200
PHOENIX AZ
85016-4661
US

V. Phone/Fax

Practice location:
  • Phone: 323-509-4325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: