Healthcare Provider Details

I. General information

NPI: 1881193175
Provider Name (Legal Business Name): ROBIN LYNN PUCKETT MAPC LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE STE 311G
GLENDALE AZ
85308-8730
US

IV. Provider business mailing address

PO BOX 5836
SUN CITY WEST AZ
85376-5836
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-2029
  • Fax:
Mailing address:
  • Phone: 623-694-0866
  • Fax: 623-975-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC12884
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: