Provider Demographics
NPI:1912310913
Name:ROSSI, JOSETTE (LISAC, BHP)
Entity type:Individual
Prefix:
First Name:JOSETTE
Middle Name:
Last Name:ROSSI
Suffix:
Gender:F
Credentials:LISAC, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4293
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123-2669
Mailing Address - Country:US
Mailing Address - Phone:888-687-7332
Mailing Address - Fax:
Practice Address - Street 1:16286 S SUNLAND GIN RD #4293
Practice Address - Street 2:THE RIVER SOURCE
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85123
Practice Address - Country:US
Practice Address - Phone:888-687-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11613101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)