Basic Information
| Provider Information | |||||||||
| NPI: | 1245613447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEROZEPURWALLA | ||||||||
| FirstName: | ARBITA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15801 W APACHE ST | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853389400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024340442 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3807 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850145005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022586797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 09/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LPC-16111 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 15040 | AZ | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | LPC-16111 | 01 | AZ | ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS | OTHER | LISAC-15040 | 01 | AZ | ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS | OTHER |