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General NPI Number Information
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NPI Number | 1154125771
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Entity Type | Individual
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Provider Name | GRISELDA ERIKA CASTELLANOS AYALA LAC
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 20325 N 51ST AVE STE 168
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City | GLENDALE
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State | AZ
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Zip | 85308-4624
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Country | US
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Telephone | 844-385-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 1517 S WESTERN SKIES DR
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City | GILBERT
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State | AZ
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Zip | 85296-4327
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-23123
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License Number State | AZ
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