Provider Demographics
NPI:1699081828
Name:JESUS, FRANK Q (MA, LISAC)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:Q
Last Name:JESUS
Suffix:
Gender:M
Credentials:MA, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3625
Mailing Address - Country:US
Mailing Address - Phone:602-241-6656
Mailing Address - Fax:602-264-4520
Practice Address - Street 1:730 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-3625
Practice Address - Country:US
Practice Address - Phone:602-241-6656
Practice Address - Fax:602-264-4520
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0048101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)