Individual
JULIO C LANDERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
3003 HIWAY 95, SUITE 104, BULLHEAD CITY, AZ 86442-7860
(888) 459-1600
(928) 763-3753
Mailing address
3003 HIWAY 95, SUITE 104, BULLHEAD CITY, AZ 86442-7860
(888) 459-1600
(928) 763-3753
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1697
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0189
DOT/SAP
AZ
01
—
1697
LISAC
AZ
01
—
20715
ICADC
AZ
Enumeration date
02/02/2008
Last updated
02/02/2008
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