MEDICARE: JOSE F AMPARO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-16249	AZ

General Provider Information

NPI Number	:	1154917250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE F AMPARO LPC

Provider Business Mailing Address
First Line	:	868 E UNIVERSITY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-8033
Country	:	US
Telephone Number	:	480-969-4024
Fax Number	:

Provider Business Practice Location Address
First Line	:	8581 N 61ST AVE BLDG A
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5493
Country	:	US
Telephone Number	:	623-934-1991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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Directions to “ JOSE F AMPARO LPC” Practice Location

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