Individual
MS. NICOLE RERUCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2620 N 140TH AVE, GOODYEAR, AZ 85395-2437
(602) 692-2526
Mailing address
7427 W HILL LN, GLENDALE, AZ 85310-5627
(602) 692-2526
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC19228
AZ
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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