Healthcare Provider Details

I. General information

NPI: 1851852586
Provider Name (Legal Business Name): SANJAY KESTNER MC LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N 27TH AVE
PHOENIX AZ
85009-4420
US

IV. Provider business mailing address

3807 N 7TH ST
PHOENIX AZ
85014-5005
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax:
Mailing address:
  • Phone: 602-258-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: