Healthcare Provider Details

I. General information

NPI: 1629847280
Provider Name (Legal Business Name): LOURDES IBARRA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 19TH TER
KANSAS CITY MO
64108-2026
US

IV. Provider business mailing address

2313 N PRESIDENTIAL DR
FLORENCE AZ
85132-6702
US

V. Phone/Fax

Practice location:
  • Phone: 520-247-4313
  • Fax:
Mailing address:
  • Phone: 520-247-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC23139
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: