Healthcare Provider Details

I. General information

NPI: 1104783083
Provider Name (Legal Business Name): HEIDI PINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19820 N 7TH ST STE 145
PHOENIX AZ
85024-1691
US

IV. Provider business mailing address

12061 N 53RD AVE
GLENDALE AZ
85304-2708
US

V. Phone/Fax

Practice location:
  • Phone: 602-859-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24536
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: