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General NPI Number Information
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NPI Number | 1427289560
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Entity Type | Individual
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Provider Name | STEVEN RAY ISHAM M.A., L.B.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 2402 N 112TH LN
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City | AVONDALE
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State | AZ
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Zip | 85392-5849
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Country | US
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Telephone | 623-907-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 2402 N 112TH LN
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City | AVONDALE
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State | AZ
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Zip | 85392-5849
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Country | US
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Telephone | 623-907-2828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LBSW-1365
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License Number State | AZ
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