Healthcare Provider Details

I. General information

NPI: 1417695974
Provider Name (Legal Business Name): REBECCA ANABEL MADRIGAL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECA MADRIGAL

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7522 N ALSUP RD
LITCHFIELD PARK AZ
85340-9657
US

IV. Provider business mailing address

1400 E SOUTHERN AVE STE 735
TEMPE AZ
85282-5699
US

V. Phone/Fax

Practice location:
  • Phone: 623-512-9368
  • Fax: 480-804-0083
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24143
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: