Provider Demographics
NPI:1215037130
Name:EDALATIAN, NEZHAT M (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:NEZHAT
Middle Name:M
Last Name:EDALATIAN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:NEZHAT
Other - Middle Name:M
Other - Last Name:EDALATIAN-MCCAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC
Mailing Address - Street 1:7601 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4706
Mailing Address - Country:US
Mailing Address - Phone:602-510-8012
Mailing Address - Fax:480-317-9867
Practice Address - Street 1:5251 N 16TH ST
Practice Address - Street 2:SUITE 707
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3217
Practice Address - Country:US
Practice Address - Phone:602-510-8012
Practice Address - Fax:480-317-9867
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-2526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health