Healthcare Provider Details

I. General information

NPI: 1619616554
Provider Name (Legal Business Name): BRENTON WEJROWSKI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 S MILL AVE STE 7C
TEMPE AZ
85282-2153
US

IV. Provider business mailing address

2210 S MILL AVE STE 7C
TEMPE AZ
85282-2153
US

V. Phone/Fax

Practice location:
  • Phone: 480-400-9615
  • Fax:
Mailing address:
  • Phone: 480-400-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-22788
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: