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General NPI Number Information
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NPI Number | 1174764716
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Entity Type | Organization
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Legal Business Name | GISHKIN AND ASSOCIATES PLLC
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 9445 S 50TH ST
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City | PHOENIX
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State | AZ
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Zip | 85044-5629
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Country | US
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Telephone | 602-708-4719
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Fax | 602-680-1260
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Provider Business Mailing Address
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Address Line | 9445 S 50TH ST
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City | PHOENIX
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State | AZ
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Zip | 85044-5629
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Country | US
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Telephone | 602-708-4719
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Fax | 602-680-1260
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JEFFREY MARK GISHKIN
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Credential | MC,LPC,LISAC
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Telephone | 602-708-4719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LISAC-0181
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-0079
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License Number State | AZ
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