Healthcare Provider Details

I. General information

NPI: 1245367747
Provider Name (Legal Business Name): ANITA LUCERO COMSTOCK GUIDANCE COUNSELOR K
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2851 S AVENUE B BLDG 20
YUMA AZ
85364-7726
US

IV. Provider business mailing address

901 PALMCROFT DR
YUMA AZ
85364
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2434
  • Fax: 928-336-2435
Mailing address:
  • Phone: 928-502-8004
  • Fax: 928-502-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-15552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: