Healthcare Provider Details

I. General information

NPI: 1376303214
Provider Name (Legal Business Name): LUCY GUADALUPE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 E RAINTREE DR STE 120
SCOTTSDALE AZ
85260-7310
US

IV. Provider business mailing address

8068 E VIRGINIA AVE
SCOTTSDALE AZ
85257-1735
US

V. Phone/Fax

Practice location:
  • Phone: 425-890-2270
  • Fax:
Mailing address:
  • Phone: 425-890-2270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLAMFT-08043T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: