MEDICARE: JACQUELINE DANETH VARELA-MANRIQUEZ

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		AZ

General Provider Information

NPI Number	:	1316798341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE DANETH VARELA-MANRIQUEZ

Provider Business Mailing Address
First Line	:	1345 E MAIN ST STE 104
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-8950
Country	:	US
Telephone Number	:	602-785-3133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1345 E MAIN ST STE 104
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-8950
Country	:	US
Telephone Number	:	602-785-3133
Fax Number	:

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

Provider Enumeration Date	:	03/28/2024
Last Update Date	:	03/28/2024

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