Provider Demographics
NPI:1356704068
Name:ELZY, RAAKEL
Entity type:Individual
Prefix:MRS
First Name:RAAKEL
Middle Name:
Last Name:ELZY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 N EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5509
Mailing Address - Country:US
Mailing Address - Phone:520-440-7435
Mailing Address - Fax:
Practice Address - Street 1:2915 N EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5509
Practice Address - Country:US
Practice Address - Phone:520-440-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-0209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst