Individual
JACOB TY PEHRSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
17505 N 79TH AVE STE 410, GLENDALE, AZ 85308-8732
(623) 800-7980
Mailing address
17505 N 79TH AVE STE 410, GLENDALE, AZ 85308-8732
(623) 800-7980
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-20054
AZ
Other
Enumeration date
07/09/2021
Last updated
07/23/2021
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