Healthcare Provider Details

I. General information

NPI: 1689065005
Provider Name (Legal Business Name): LIZ PLOTKIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9855 S PRIEST DR STE 102
TEMPE AZ
85284-3605
US

IV. Provider business mailing address

PO BOX 11373
CHANDLER AZ
85248-0007
US

V. Phone/Fax

Practice location:
  • Phone: 480-616-4141
  • Fax:
Mailing address:
  • Phone: 480-616-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13990
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-13990
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: