Healthcare Provider Details

I. General information

NPI: 1497329320
Provider Name (Legal Business Name): MARCO MARISCAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S DOBSON RD STE 301
MESA AZ
85202-6490
US

IV. Provider business mailing address

2222 S DOBSON RD STE 301
MESA AZ
85202-6490
US

V. Phone/Fax

Practice location:
  • Phone: 480-581-0320
  • Fax:
Mailing address:
  • Phone: 602-617-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22504
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: