Provider Demographics
NPI:1891325650
Name:BERRY, ELIZABETH K (MC, LPC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:K
Last Name:BERRY
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 E THOMAS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7702
Mailing Address - Country:US
Mailing Address - Phone:480-902-0771
Mailing Address - Fax:602-795-1663
Practice Address - Street 1:1830 S ALMA SCHOOL RD STE 130
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3088
Practice Address - Country:US
Practice Address - Phone:480-902-0771
Practice Address - Fax:602-795-1663
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional