Individual
JOHN PEMBERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
711 S GRANITE ST, PRESCOTT, AZ 86303-4241
(928) 713-2167
Mailing address
9340 E RANCHO VISTA DR, PRESCOTT VALLEY, AZ 86314-7160
(928) 713-2167
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
LCSW-22817
AZ
Other
Enumeration date
09/05/2023
Last updated
02/21/2025
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