Healthcare Provider Details

I. General information

NPI: 1023894169
Provider Name (Legal Business Name): REBECCA WIGTON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 209
MESA AZ
85204-6679
US

IV. Provider business mailing address

1910 S STAPLEY DR STE 209
MESA AZ
85204-6679
US

V. Phone/Fax

Practice location:
  • Phone: 480-351-8020
  • Fax:
Mailing address:
  • Phone: 480-351-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24606
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: