MEDICARE: MR. BEN HEDBERG LPC

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
1	101YM0800X	Mental Health Counselor	LPC-1992	AZ

General Provider Information

NPI Number	:	1134117823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BEN HEDBERG LPC

Provider Business Mailing Address
First Line	:	4545 E SHEA BLVD
Second Line	:	SUITE 240
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3074
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4545 E SHEA BLVD
Second Line	:	SUITE 240
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3074
Country	:	US
Telephone Number	:	602-347-8100
Fax Number	:	602-242-0887

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. BEN HEDBERG LPC” Practice Location

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