Healthcare Provider Details

I. General information

NPI: 1174486781
Provider Name (Legal Business Name): MAKKELL BAILLARGEON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6602 E CARONDELET DR
TUCSON AZ
85710-2119
US

IV. Provider business mailing address

17475 S RIDGERUNNER DR
VAIL AZ
85641-1465
US

V. Phone/Fax

Practice location:
  • Phone: 520-524-4757
  • Fax:
Mailing address:
  • Phone: 406-230-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-08263T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: