1134761513 NPI number — CLAUDIA PATRICIA SALAS-SULLIVAN MA, LPC

Table of content: CLAUDIA PATRICIA SALAS-SULLIVAN MA, LPC (NPI 1134761513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134761513 NPI number — CLAUDIA PATRICIA SALAS-SULLIVAN MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALAS-SULLIVAN
Provider First Name:
CLAUDIA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SALAS
Provider Other First Name:
CLAUDIA
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134761513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2024 E BOSTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85225-5879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-210-2713
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 E WILLIAMS FIELD RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85295-0764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-581-5900
Provider Business Practice Location Address Fax Number:
480-581-5959
Provider Enumeration Date:
10/17/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  LPC18482 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)