Provider Demographics
NPI:1093316978
Name:ESCOBEDO, ERICA E (LAC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:ESCOBEDO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 ALPINE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1101
Mailing Address - Country:US
Mailing Address - Phone:505-510-2265
Mailing Address - Fax:
Practice Address - Street 1:7254 E SOUTHERN AVE STE 106
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2787
Practice Address - Country:US
Practice Address - Phone:505-510-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17890101YM0800X
AZLPC-22173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health