Jirak, Jeffrey S
Jirak, Jeffrey S is an sole proprietor health care provider with primary practice located at 11851 N 51St Ave Ste B110 , Glendale AZ 85304-2823. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Jirak, Jeffrey S can be contacted via phone (480) 882-4545.Contact Information
Primary practice address
11851 N 51St Ave Ste B110
Glendale AZ 85304-2823
Phone: (480) 882-4545
Fax: (623) 773-2267
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | LISAC-10590 | Arizona |
Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | LPC-2320 | Arizona |
Profile Details
NPI number | 1063565455 |
---|---|
LBN Legal business name | Jirak, Jeffrey S |
Credentials | LPC, LISAC |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jan 19th, 2007 |
Last updated | May 11th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1063565455 | NPPES |
Arizona | MEDICAID | 646316 |
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