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NPI Code Detail

MEDICARE: JEFFREY S JIRAK LPC, LISAC

MEDICARE: JEFFREY S JIRAK LPC, LISAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLISAC-10590AZ
2101YM0800XMental Health CounselorLPC-2320AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063565455
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY S JIRAK LPC, LISAC
Provider Business Mailing Address
First Line : 7500 N DREAMY DRAW DR STE 145
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-4668
Country : US
Telephone Number : 480-882-4545
Fax Number : 480-882-5814
Provider Business Practice Location Address
First Line : 11851 N 51ST AVE STE B110
Second Line :
City : GLENDALE
State : AZ
Zip : 85304-2823
Country : US
Telephone Number : 480-882-4545
Fax Number : 623-773-2267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 05/11/2023

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