Individual
EZRA LAVINSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LLC
Contact information
Practice address
1579 W GURLEY ST, PRESCOTT, AZ 86305-2829
(928) 713-3658
Mailing address
4656 E CHESHIRE LOOP, PRESCOTT VALLEY, AZ 86314-0086
(928) 499-1951
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC-22856
AZ
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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