MEDICARE: MS. MARY SIMS GERDES 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-10079	AZ

General Provider Information

NPI Number	:	1770638272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY SIMS GERDES LPC

Provider Business Mailing Address
First Line	:	2635 E DARREL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5937
Country	:	US
Telephone Number	:	480-444-8723
Fax Number	:	480-907-2295

Provider Business Practice Location Address
First Line	:	2415 E CAMELBACK RD
Second Line	:	SUITE 700
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4288
Country	:	US
Telephone Number	:	480-444-8723
Fax Number	:	480-907-2295

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/17/2015

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