Healthcare Provider Details

I. General information

NPI: 1467360578
Provider Name (Legal Business Name): ALEXIS MARCELA BAMBAUER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 N CRAYCROFT RD STE 100
TUCSON AZ
85712-2811
US

IV. Provider business mailing address

2224 N CRAYCROFT RD STE 100
TUCSON AZ
85712-2811
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-1400
  • Fax: 520-614-6050
Mailing address:
  • Phone: 520-896-1400
  • Fax: 520-614-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23523
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: