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General NPI Number Information
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NPI Number | 1265726756
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Entity Type | Individual
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Provider Name | GLORIA M ROSALES LISAC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 9405 S AVENIDA DEL YAQUI
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City | GUADALUPE
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State | AZ
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Zip | 85283-2529
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Country | US
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Telephone | 480-768-2087
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Fax | 480-768-2053
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Provider Business Mailing Address
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Address Line | 9405 S AVENIDA DEL YAQUI
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City | GUADALUPE
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State | AZ
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Zip | 85283
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Country | US
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Telephone | 480-768-2087
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Fax | 480-768-2053
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LISAC-0429
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License Number State | AZ
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