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Individual

JOB ELLIOTT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
L.I.S.A.C., L.A.C.

Contact information

Practice address
4105 W SAINT CHARLES AVE, PHOENIX, AZ 85041
(480) 233-5511
Mailing address
4105 W SAINT CHARLES AVE, PHOENIX, AZ 85041-4980
(480) 233-5511

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
LAC-15368
AZ
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC-15039
AZ

Other

Enumeration date
12/23/2015
Last updated
12/23/2015
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