MEDICARE: MRS. DARCY DUDLESTON BRACAMONTE LIAC, 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-24561	AZ
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LIAC-11520	AZ

General Provider Information

NPI Number	:	1902264773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DARCY DUDLESTON BRACAMONTE LIAC, LPC

Provider Business Mailing Address
First Line	:	17505 N 79TH AVE STE 311F
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8730
Country	:	US
Telephone Number	:	623-850-5404
Fax Number	:

Provider Business Practice Location Address
First Line	:	17505 N. 79TH AVE
Second Line	:	302A
City	:	GLENDALE
State	:	AZ
Zip	:	85308
Country	:	US
Telephone Number	:	623-850-5404
Fax Number	:

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

Provider Enumeration Date	:	02/08/2016
Last Update Date	:	03/24/2026

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