=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619869088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNE SA-FIRE ANGELES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2025
-----------------------------------------------------
Last Update Date | 07/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2066 W APACHE TRL STE 101
-----------------------------------------------------
City | APACHE JUNCTION
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85120-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-999-3323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10617 E WAVELENGTH AVE
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85212-8712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-865-0202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------