Healthcare Provider Details

I. General information

NPI: 1679704803
Provider Name (Legal Business Name): VICTORIA LYNN LOMELINO-TEWA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA LYNN TEWA LPC

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE FL 18
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

9298 SLAYTON RANCH RD
FLAGSTAFF AZ
86004-3373
US

V. Phone/Fax

Practice location:
  • Phone: 646-453-6777
  • Fax: 929-596-7897
Mailing address:
  • Phone: 505-205-6215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0115211
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16273
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: