Healthcare Provider Details

I. General information

NPI: 1134761513
Provider Name (Legal Business Name): CLAUDIA PATRICIA SALAS-SULLIVAN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA PATRICIA SALAS MA, LAC

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

2108 E THOMAS RD STE 130
PHOENIX AZ
85016-0008
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0990
  • Fax: 602-933-4251
Mailing address:
  • Phone: 602-933-3124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC18482
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-18482
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: