Healthcare Provider Details

I. General information

NPI: 1760496525
Provider Name (Legal Business Name): JEF GAZLEY LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JEF GAZLEY MSPC

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 E KELTON LN
SCOTTSDALE AZ
85254-1406
US

IV. Provider business mailing address

6540 E KELTON LN
SCOTTSDALE AZ
85254-1406
US

V. Phone/Fax

Practice location:
  • Phone: 480-998-0560
  • Fax: 480-998-1058
Mailing address:
  • Phone: 480-998-0560
  • Fax: 480-998-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC0023
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC0046
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT0090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: