Individual
MAXINE MANDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3130 E CABALLERO ST, MESA, AZ 85213-7902
(480) 641-3066
(866) 868-8445
Mailing address
PO BOX 31803, MESA, AZ 85275-1803
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LISAC - 0689
AZ
101YP2500X
Professional Counselor
LPC-0793
AZ
106H00000X
Marriage & Family Therapist
Primary
LMFT - 0339
AZ
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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