Healthcare Provider Details

I. General information

NPI: 1912728312
Provider Name (Legal Business Name): RUTH MARIA BANTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 S 52ND ST STE 101
TEMPE AZ
85281-9500
US

IV. Provider business mailing address

9375 E SHEA BLVD STE 100
SCOTTSDALE AZ
85260-6986
US

V. Phone/Fax

Practice location:
  • Phone: 480-784-1514
  • Fax:
Mailing address:
  • Phone: 480-992-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: