Healthcare Provider Details

I. General information

NPI: 1487510558
Provider Name (Legal Business Name): ALEXIS MARIE FUENTES MAS-MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 E CADENCE PKWY APT 1146
MESA AZ
85212-0107
US

IV. Provider business mailing address

1600 W LA JOLLA DR APT 2239
TEMPE AZ
85282-4492
US

V. Phone/Fax

Practice location:
  • Phone: 480-359-7876
  • Fax:
Mailing address:
  • Phone: 480-359-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: