Individual
TALLY ISKOVITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1424 S STAPLEY DR, ANASAZI FOUNDATION - SAN TAN COUNSELING, MESA, AZ 85204-5877
(480) 982-2356
Mailing address
1424 S STAPLEY DR, ANASAZI FOUNDATION, MESA, AZ 85204-5877
(480) 982-2356
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-13677
AZ
101YM0800X
Mental Health Counselor
LPC-13677
AZ
101YP2500X
Professional Counselor
Primary
LPC-13677
AZ
Other
Enumeration date
04/17/2009
Last updated
08/01/2012
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