Individual
MR. ELMER GEORGE MYRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LBSW, LISAC
Contact information
Practice address
4041 N. CENTRAL AVE, BUILDING C, PHOENIX, AZ 85012-3133
(602) 279-5262
(602) 279-5393
Mailing address
4011 W COLUMBINE DR, PHOENIX, AZ 85029-2970
(602) 481-6717
(602) 279-5393
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11597
AZ
104100000X
Social Worker
4125
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910209
—
AZ
Enumeration date
05/24/2007
Last updated
08/29/2014
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