Provider Demographics
NPI:1124130018
Name:DEGUILIO, MARY M (MC, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:DEGUILIO
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 N 7TH ST
Mailing Address - Street 2:STE. 4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4388
Mailing Address - Country:US
Mailing Address - Phone:602-993-4595
Mailing Address - Fax:602-993-7440
Practice Address - Street 1:14045 N 7TH ST
Practice Address - Street 2:STE. 4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4388
Practice Address - Country:US
Practice Address - Phone:602-993-4595
Practice Address - Fax:602-993-7440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional