Individual
MS. LORETTTA CANTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 N 114TH AVE, AVONDALE, AZ 85323-5034
(623) 478-7420
Mailing address
2501 N 114TH AVE, AVONDALE, AZ 85323-5034
(623) 478-7420
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
9845
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
944927
AHCCCS ID NUMBER
—
Enumeration date
11/21/2006
Last updated
07/08/2007
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