Healthcare Provider Details

I. General information

NPI: 1699450551
Provider Name (Legal Business Name): ELISAVET RUELAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA RUELAS

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 W PINNACLE PEAK RD STE 220
PHOENIX AZ
85027-1224
US

IV. Provider business mailing address

2222 W PINNACLE PEAK RD STE 220
PHOENIX AZ
85027-1224
US

V. Phone/Fax

Practice location:
  • Phone: 480-347-4480
  • Fax:
Mailing address:
  • Phone: 480-347-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-24790
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: