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General NPI Number Information
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NPI Number | 1912155367
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Entity Type | Organization
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Legal Business Name | SONORAN LIFE SOLUTIONS, INC.
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 13460 N 94TH DR K-3
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City | PEORIA
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State | AZ
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Zip | 85381-4835
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Country | US
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Telephone | 623-974-3333
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Fax | 623-974-3390
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Provider Business Mailing Address
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Address Line | 13460 N 94TH DR K-3
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City | PEORIA
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State | AZ
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Zip | 85381-4835
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Country | US
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Telephone | 623-974-3333
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Fax |
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Authorized Official
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Title or Position | THERAPIST/PRESIDENT
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Name | MRS. VALERIE ALYSE GIROD
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Credential | LPC
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Telephone | 162-397-4333
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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 | LPC2537
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License Number State | AZ
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