Healthcare Provider Details

I. General information

NPI: 1013747674
Provider Name (Legal Business Name): DARLENE RAYET CORRALES LSAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E BASELINE RD STE 5
PHOENIX AZ
85042-6536
US

IV. Provider business mailing address

12859 S 175TH AVE
GOODYEAR AZ
85338-5862
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax:
Mailing address:
  • Phone: 951-529-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15663
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: