=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588739197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY A EMERSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 S JENTILLY LN SUITE #C2
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85281-5758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-829-9585
-----------------------------------------------------
Fax | 480-962-5282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1753 E BROADWAY RD SUITE 101-259
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-2081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-829-9585
-----------------------------------------------------
Fax | 480-962-5282
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LCSW 2591
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------