Healthcare Provider Details

I. General information

NPI: 1114843786
Provider Name (Legal Business Name): CLARISSA MARIE TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13395 N MARANA MAIN ST
MARANA AZ
85653-7008
US

IV. Provider business mailing address

7759 N SILVERBELL RD APT 26206
TUCSON AZ
85743-7231
US

V. Phone/Fax

Practice location:
  • Phone: 520-682-4111
  • Fax:
Mailing address:
  • Phone: 520-682-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24935
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: