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General NPI Number Information
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NPI Number | 1598090151
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Entity Type | Individual
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Provider Name | DEOGRATIAS BARANSAKA MA
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Gender | Male
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 10/13/2024
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Provider Practice Location Address
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Address Line | 7215 W IRONWOOD DR
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City | PEORIA
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State | AZ
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Zip | 85345-6805
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Country | US
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Telephone | 623-760-8378
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Fax | 623-594-8992
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Provider Business Mailing Address
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Address Line | 7215 W IRONWOOD DR
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City | PEORIA
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State | AZ
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Zip | 85345-6805
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Country | US
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Telephone | 623-760-8378
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Fax | 623-594-8992
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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 | BH4311
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License Number State | AZ
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