Individual
PROF. STEVEN RAY ISHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., L.B.S.W.
Contact information
Practice address
2402 N 112TH LN, AVONDALE, AZ 85392-5849
(623) 907-2828
Mailing address
2402 N 112TH LN, AVONDALE, AZ 85392-5849
(623) 907-2828
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
104100000X
Social Worker
Primary
LBSW-1365
AZ
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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