MEDICARE: MS. ISABELLA VENTO MA, LPC, NCC

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	101YM0800X	Mental Health Counselor	LPC-21986	AZ

General Provider Information

NPI Number	:	1982215521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ISABELLA VENTO MA, LPC, NCC

Provider Business Mailing Address
First Line	:	2899 E MAGDALENA DR
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85143-1643
Country	:	US
Telephone Number	:	602-291-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	4657 S LAKESHORE DR STE 1
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7170
Country	:	US
Telephone Number	:	480-718-1261
Fax Number	:

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

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	07/17/2024

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