Provider Demographics
NPI:1174764716
Name:GISHKIN AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:GISHKIN AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MC,LPC,LISAC
Authorized Official - Phone:602-708-4719
Mailing Address - Street 1:9445 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5629
Mailing Address - Country:US
Mailing Address - Phone:602-708-4719
Mailing Address - Fax:602-680-1260
Practice Address - Street 1:9445 S 50TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-5629
Practice Address - Country:US
Practice Address - Phone:602-708-4719
Practice Address - Fax:602-680-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0181101YA0400X
AZLPC-0079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ384249Medicaid