Healthcare Provider Details

I. General information

NPI: 1639777220
Provider Name (Legal Business Name): MARY E PALS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 N CAVE CREEK RD
PHOENIX AZ
85032-2976
US

IV. Provider business mailing address

312 N ALMA SCHOOL RD STE 11
CHANDLER AZ
85224-4354
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax: 602-910-2941
Mailing address:
  • Phone: 623-300-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19259
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-19259
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: