Individual
SHAUN EDGAR OLDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LASAC
Contact information
Practice address
2102 W BETHANY HOME RD, PHOENIX, AZ 85015-1935
(480) 208-8505
Mailing address
2102 W BETHANY HOME RD, PHOENIX, AZ 85015-1935
(027) 744-4745
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
08007T
AZ
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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