Provider Demographics
NPI:1124782958
Name:TAPIA, MAURA RUTH ANNALYSSE (LAC)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:RUTH ANNALYSSE
Last Name:TAPIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 1ST AVE STE 2310
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1902
Mailing Address - Country:US
Mailing Address - Phone:312-578-9990
Mailing Address - Fax:
Practice Address - Street 1:1854 E INTREPID AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6817
Practice Address - Country:US
Practice Address - Phone:480-600-0548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-19829101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health