MEDICARE: LIZETH BANUELOS

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-24934	AZ

General Provider Information

NPI Number	:	1881529956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZETH BANUELOS

Provider Business Mailing Address
First Line	:	PO BOX 127
Second Line	:
City	:	KEOKUK
State	:	IA
Zip	:	52632-0127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3514 N POWER RD STE 127
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85215-2911
Country	:	US
Telephone Number	:	480-847-2800
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ LIZETH BANUELOS ” Practice Location

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