MEDICARE: MS. MARY HELEN FIMBRES MSW MHR LCSW ACSW

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	LCSW0551	AZ

General Provider Information

NPI Number	:	1790951002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY HELEN FIMBRES MSW MHR LCSW ACSW

Provider Business Mailing Address
First Line	:	5400 W NORTHERN
Second Line	:	#117 NORTHERN EXECUTIVE PLAZA
City	:	GLENDALE
State	:	AZ
Zip	:	85301
Country	:	US
Telephone Number	:	623-937-3556
Fax Number	:	623-937-3557

Provider Business Practice Location Address
First Line	:	5400 W NORTHERN
Second Line	:	#117 NORTHERN EXECUTIVE PLAZA
City	:	GLENDALE
State	:	AZ
Zip	:	85301
Country	:	US
Telephone Number	:	623-937-3556
Fax Number	:	623-937-3557

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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