MEDICARE: MILENA ABRAHA LAC

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-21379	AZ

General Provider Information

NPI Number	:	1306692702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILENA ABRAHA LAC

Provider Business Mailing Address
First Line	:	5851 S 23RD WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3499
Country	:	US
Telephone Number	:	602-380-4336
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 S 23RD WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3499
Country	:	US
Telephone Number	:	602-380-4336
Fax Number	:

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

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	04/25/2024

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Directions to “ MILENA ABRAHA LAC” Practice Location

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