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General NPI Number Information
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NPI Number | 1881529956
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Entity Type | Individual
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Provider Name | LIZETH BANUELOS
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Gender | Female
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Dates
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Enumeration Date | 06/17/2026
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Last Update Date | 06/17/2026
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Provider Practice Location Address
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Address Line | 3514 N POWER RD STE 127
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City | MESA
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State | AZ
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Zip | 85215-2911
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Country | US
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Telephone | 480-847-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 127
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City | KEOKUK
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State | IA
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Zip | 52632-0127
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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 | LPC-24934
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License Number State | AZ
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