Healthcare Provider Details

I. General information

NPI: 1114852274
Provider Name (Legal Business Name): ERROLD GLENN ELAD DBH, MA, MS, LAAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 E THOMAS RD
SCOTTSDALE AZ
85251-6826
US

IV. Provider business mailing address

4424 E BASELINE RD APT 1133
PHOENIX AZ
85042-7446
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-4745
  • Fax:
Mailing address:
  • Phone: 818-325-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAAC-15651
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: