MEDICARE: GINA S METROFF LPC

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	LPC 10034	AZ

General Provider Information

NPI Number	:	1366698193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA S METROFF LPC

Provider Business Mailing Address
First Line	:	21620 N 19TH AVE
Second Line	:	SUITE A-102
City	:	PHOENIX
State	:	AZ
Zip	:	85027-2716
Country	:	US
Telephone Number	:	602-751-5584
Fax Number	:

Provider Business Practice Location Address
First Line	:	21620 N 19TH AVE
Second Line	:	SUITE A-102
City	:	PHOENIX
State	:	AZ
Zip	:	85027-2716
Country	:	US
Telephone Number	:	602-751-5584
Fax Number	:

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	05/24/2016

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