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General NPI Number Information
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NPI Number | 1407508062
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Entity Type | Individual
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Provider Name | CASSANDRA LARUSSA CISNEROS LPC
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Gender | Female
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 2577 E DONATO DR
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City | GILBERT
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State | AZ
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Zip | 85298-8490
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Country | US
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Telephone | 480-242-4193
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Fax |
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Provider Business Mailing Address
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Address Line | 27818 N 24TH LN
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City | PHOENIX
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State | AZ
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Zip | 85085-4706
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-24006
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License Number State | AZ
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