Healthcare Provider Details

I. General information

NPI: 1902953177
Provider Name (Legal Business Name): PILAR VARGAS-BRYA PSY.D., LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 E BROADWAY RD SUITE 120
TEMPE AZ
85282-1511
US

IV. Provider business mailing address

1232 E BROADWAY RD SUITE 120
TEMPE AZ
85282-1511
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax: 480-784-3528
Mailing address:
  • Phone: 480-784-1514
  • Fax: 480-784-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLISAC-10871
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: