Healthcare Provider Details

I. General information

NPI: 1053038901
Provider Name (Legal Business Name): PATRICIA P DAVILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE C144
PHOENIX AZ
85051-9582
US

IV. Provider business mailing address

10000 N 31ST AVE
PHOENIX AZ
85051-9582
US

V. Phone/Fax

Practice location:
  • Phone: 602-341-3232
  • Fax:
Mailing address:
  • Phone: 602-341-3232
  • Fax: 518-722-2593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24721
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: