Individual
JOHANA VANESSA BASURTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12104 E RYSCOTT CIR, VAIL, AZ 85641-0255
(928) 366-4541
Mailing address
12104 E RYSCOTT CIR, VAIL, AZ 85641-0255
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-16826
AZ
Other
Enumeration date
04/16/2025
Last updated
04/16/2025
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