Healthcare Provider Details

I. General information

NPI: 1619476793
Provider Name (Legal Business Name): A'NNA JURICH LCPC, LPC, CRADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BREWERY AVE
BISBEE AZ
85603-1041
US

IV. Provider business mailing address

PO BOX 729
BISBEE AZ
85603-0729
US

V. Phone/Fax

Practice location:
  • Phone: 618-738-0367
  • Fax:
Mailing address:
  • Phone: 618-738-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-004996
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-23403
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: