Healthcare Provider Details

I. General information

NPI: 1568808111
Provider Name (Legal Business Name): ANNIA SALAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 W 2ND PL
MESA AZ
85201-6410
US

IV. Provider business mailing address

529 W 2ND PL
MESA AZ
85201-6410
US

V. Phone/Fax

Practice location:
  • Phone: 602-486-9172
  • Fax:
Mailing address:
  • Phone: 602-486-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC15763
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61527329
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: