Individual
LICA SERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
806 S 56TH AVE STE 1B, PHOENIX, AZ 85043-4630
(602) 429-0447
Mailing address
806 S 56TH AVE STE 1B, PHOENIX, AZ 85043-4630
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171400000X
Health & Wellness Coach
—
—
246ZE0500X
EEG Specialist/Technologist
Primary
—
—
Other
Enumeration date
09/15/2016
Last updated
06/07/2022
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