Individual
DR. SUZANNE ANDRY BOTELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPC
Contact information
Practice address
1538 W DAYDREAM DR, FLAGSTAFF, AZ 86001-7212
(928) 266-3770
Mailing address
1538 W DAYDREAM DR, FLAGSTAFF, AZ 86001-7212
(928) 266-3770
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC-2539
AZ
103TC1900X
Counseling Psychologist
Primary
4765
AZ
103TP2701X
Group Psychotherapy Psychologist
4765
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03029048
TRANSACTION PRIVILEGE TAX NUMBER
AZ
Enumeration date
05/20/2020
Last updated
05/20/2020
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