Healthcare Provider Details

I. General information

NPI: 1790692705
Provider Name (Legal Business Name): ALERON TOLEDO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD STE E454
GLENDALE AZ
85306-4646
US

IV. Provider business mailing address

7300 N DREAMY DRAW DR UNIT 228
PHOENIX AZ
85020-5247
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-3010
  • Fax:
Mailing address:
  • Phone: 480-870-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18779
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: