Provider Demographics
NPI:1144775123
Name:BEZERGIANOV, ROUMEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROUMEN
Middle Name:
Last Name:BEZERGIANOV
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S GILBERT RD
Mailing Address - Street 2:#204
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4441
Mailing Address - Country:US
Mailing Address - Phone:480-507-8619
Mailing Address - Fax:
Practice Address - Street 1:943 S GILBERT RD
Practice Address - Street 2:#204
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4441
Practice Address - Country:US
Practice Address - Phone:480-507-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC13900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional