Individual
MAY DO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4577 W PECOS RD, LAVEEN, AZ 85339-9002
(602) 989-2779
Mailing address
4577 W PECOS RD, LAVEEN, AZ 85339-9002
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-20929
AZ
106S00000X
Behavior Technician
LPC-20929
AZ
Other
Enumeration date
05/06/2022
Last updated
02/09/2023
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