MEDICARE: LAURA CASTORENA 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	101YP2500X	Professional Counselor	LPC-18670	AZ

General Provider Information

NPI Number	:	1609415702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA CASTORENA LPC

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-721-1887

Provider Business Practice Location Address
First Line	:	107 E 4TH ST
Second Line	:
City	:	ELOY
State	:	AZ
Zip	:	85131-2506
Country	:	US
Telephone Number	:	520-466-7765
Fax Number	:	520-446-4475

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

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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Directions to “ LAURA CASTORENA LPC” Practice Location

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