Provider Demographics
NPI:1356517676
Name:AZEVEDO, JOSHUA LOCKE (LISAC)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:LOCKE
Last Name:AZEVEDO
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1753 E BROADWAY RD
Mailing Address - Street 2:101-280
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2081
Mailing Address - Country:US
Mailing Address - Phone:480-921-4050
Mailing Address - Fax:480-921-2673
Practice Address - Street 1:648 S RIVER DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-3012
Practice Address - Country:US
Practice Address - Phone:480-921-4050
Practice Address - Fax:480-921-2673
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1644101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)