Healthcare Provider Details

I. General information

NPI: 1689953754
Provider Name (Legal Business Name): ROBERTO SANTILLAN M.A. - COUNSELING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 HANCOCK RD
BULLHEAD CITY AZ
86442-5946
US

IV. Provider business mailing address

1004 HANCOCK RD
BULLHEAD CITY AZ
86442-5946
US

V. Phone/Fax

Practice location:
  • Phone: 928-758-3951
  • Fax: 928-758-4996
Mailing address:
  • Phone: 928-758-3951
  • Fax: 928-758-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number210026705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: