Healthcare Provider Details

I. General information

NPI: 1336337583
Provider Name (Legal Business Name): DARA N RAMPERSAD PH.D., LPC., NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 E THOMAS RD
PHOENIX AZ
85016-8134
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 200
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-302-7807
  • Fax: 602-258-6140
Mailing address:
  • Phone: 602-302-7896
  • Fax: 602-302-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-4744
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-12792
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY-1275
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: