Provider Demographics
NPI:1134117823
Name:HEDBERG, BEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:
Last Name:HEDBERG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:HEDBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-347-8100
Practice Address - Fax:602-242-0887
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health