Provider Demographics
NPI:1962691295
Name:GRIJALVA, NORMA ALICIA
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:ALICIA
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W SAINT MARYS RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2621
Mailing Address - Country:US
Mailing Address - Phone:520-628-8287
Mailing Address - Fax:520-628-8749
Practice Address - Street 1:1701 W SAINT MARYS RD
Practice Address - Street 2:SUITE 160
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2621
Practice Address - Country:US
Practice Address - Phone:520-628-8287
Practice Address - Fax:520-628-8749
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health