Provider Demographics
NPI:1487969176
Name:NOSOV, LAKISHA JESSICA (PHD)
Entity type:Individual
Prefix:DR
First Name:LAKISHA
Middle Name:JESSICA
Last Name:NOSOV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2217 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7729
Mailing Address - Country:US
Mailing Address - Phone:623-915-8411
Mailing Address - Fax:623-915-8437
Practice Address - Street 1:2217 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7729
Practice Address - Country:US
Practice Address - Phone:623-915-8411
Practice Address - Fax:623-915-8437
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4290054103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool