Healthcare Provider Details

I. General information

NPI: 1154917250
Provider Name (Legal Business Name): JOSE F AMPARO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8581 N 61ST AVE BLDG A
GLENDALE AZ
85302-5493
US

IV. Provider business mailing address

868 E UNIVERSITY DR
MESA AZ
85203-8033
US

V. Phone/Fax

Practice location:
  • Phone: 623-934-1991
  • Fax:
Mailing address:
  • Phone: 480-969-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-16249
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: