Provider Demographics
NPI:1093316978
Name:ESCOBEDO, ERICA E (LAC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 123
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4263
Mailing Address - Country:US
Mailing Address - Phone:505-510-2265
Mailing Address - Fax:480-546-4030
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 123
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4263
Practice Address - Country:US
Practice Address - Phone:505-510-2265
Practice Address - Fax:480-546-4030
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health