Individual
BEVAN GOTTLIEB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISAC
Contact information
Practice address
115 E GOODWIN ST, SUITE C, PRESCOTT, AZ 86303-3926
(928) 533-2411
Mailing address
520 ELLENWOOD DR, PRESCOTT, AZ 86303-4122
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10822
AZ
Other
Enumeration date
02/04/2014
Last updated
02/04/2014
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