Healthcare Provider Details

I. General information

NPI: 1457801367
Provider Name (Legal Business Name): ELIJAH BEDROSIAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 E ANGUS DR
SCOTTSDALE AZ
85251-6410
US

IV. Provider business mailing address

7530 E ANGUS DR
SCOTTSDALE AZ
85251-6410
US

V. Phone/Fax

Practice location:
  • Phone: 520-250-4255
  • Fax:
Mailing address:
  • Phone: 520-250-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-15544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: