Healthcare Provider Details

I. General information

NPI: 1730008871
Provider Name (Legal Business Name): JENNIFER GUADALUPE GIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 470
PHOENIX AZ
85013-3475
US

IV. Provider business mailing address

300 WEST CLARENDON PHOENIX, ARIZONA 85013 #470
PHOENIX AZ
85013
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-4450
  • Fax: 602-391-2522
Mailing address:
  • Phone: 602-730-4450
  • Fax: 602-391-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-22571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: