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Ilona Alisudjana, LAC
Counselor in Phoenix, Arizona
NPI 1811691959

Ilona Alisudjana is a Counselor based in Phoenix, AZ. Ilona Alisudjana practices in Phoenix, AZ and has the professional credentials of LAC. The NPI Number for Ilona Alisudjana is 1811691959 and holds a License No. LAC-21903 (Arizona).

The current practice location address for Ilona Alisudjana is 610 E Baseline Rd Ste 5, Phoenix, AZ and can be reached out via phone at 602-230-7373 and via fax at 602-441-5836.

Location: 610 E Baseline Rd Ste 5, Phoenix, AZ, 85012-2639
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1811691959
Provider Name
Ilona Alisudjana
Credential
LAC
Provider Entity Type
Individual
Gender
Female
Address
610 E Baseline Rd Ste 5, Phoenix, AZ, 85012-2639
Phone Number
602-230-7373
Fax Number
602-441-5836
Provider Enumeration Date
03/30/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
610 E Baseline Rd Ste 5
City
Phoenix
State
Arizona
Zip
85042-6536
Phone Number
602-230-7373
Fax Number
602-441-5836
person
Provider Business Mailing Address Details
Address
610 E Baseline Rd Ste 5
City
Phoenix
State
Arizona
Zip
85042-6536
Phone Number
602-230-7373
Fax Number
602-441-5836
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
LAC-21903 (Arizona)
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
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