Healthcare Provider Details

I. General information

NPI: 1790264158
Provider Name (Legal Business Name): VERONICA VILLANUEVA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 N 23RD AVE STE B
PHOENIX AZ
85021-4954
US

IV. Provider business mailing address

7449 E EDWARD LN
SCOTTSDALE AZ
85250-4631
US

V. Phone/Fax

Practice location:
  • Phone: 602-242-1238
  • Fax: 602-242-1264
Mailing address:
  • Phone: 480-635-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-17491
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17491
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-17491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: