Jacob Ty Pehrson, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LAC-20054 Issued in AZ

Practice address

17505 N 79TH Ave Ste 410
Glendale, AZ 85308-8732

Phone

(623) 800-7980

NPI assigned

Jul 9, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Surge Points LLC

  • Counselor
  • Glendale, AZ
  • NPI 1619428356

  Mental Health

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1457922429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17505 N 79TH AVE STE 410",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088732",
            "telephone_number": "623-800-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17505 N 79TH AVE STE 410",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088732",
            "telephone_number": "623-800-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEHRSON",
        "first_name": "JACOB",
        "middle_name": "TY",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-20054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Sedation of Arizona
• Pediatric Therapy Specialists
• Pedram Amani, MD, PLLC
• Angel Pedraza
• James Frederick Pehoushek, MD MPH
• Ty J. Pehrson, M.O.T.
• Jo Ann Pellini, M.S. CCC-SLP
• Sarah Peloquin, DO
• Michele Ann Pelusio, NP
• Nisha Pema, PHARM.D.

• Mental Health Counselor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.