Healthcare Provider Details

I. General information

NPI: 1144234188
Provider Name (Legal Business Name): GABRIELLE LAWRENCE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 E VIA LINDA STE 105
SCOTTSDALE AZ
85258-5316
US

IV. Provider business mailing address

10245 E VIA LINDA STE 105
SCOTTSDALE AZ
85258-5316
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-5030
  • Fax: 480-948-9054
Mailing address:
  • Phone: 480-607-5030
  • Fax: 480-948-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: