Provider Demographics
NPI:1558018309
Name:SESSOM, DEREK (LPC-20876)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:SESSOM
Suffix:
Gender:M
Credentials:LPC-20876
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1125
Mailing Address - Country:US
Mailing Address - Phone:623-217-1733
Mailing Address - Fax:
Practice Address - Street 1:4425 N 24TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5501
Practice Address - Country:US
Practice Address - Phone:623-217-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20876101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional