Basic Information
| Provider Information | |||||||||
| NPI: | 1750045092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENDAHL | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19427 N GABRIEL PATH | ||||||||
| Address2: | |||||||||
| City: | MARICOPA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851385699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804017515 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4041 N CENTRAL AVE BLDG C | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850123313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022795262 | ||||||||
| FaxNumber: | 6022795393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2021 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-20391 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.