MEDICARE: VANESSA BOBADILLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LAC-23734	AZ

General Provider Information

NPI Number	:	1184378689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA BOBADILLA

Provider Business Mailing Address
First Line	:	PO BOX 14545
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4038
Country	:	US
Telephone Number	:	248-436-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	9327 N 3RD ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2473
Country	:	US
Telephone Number	:	520-595-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	10/17/2025

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Directions to “ VANESSA BOBADILLA ” Practice Location

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