Provider Demographics
NPI:1003060872
Name:MINETOR, DEBRA L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MINETOR
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CAPS CAMPUS HEALTH SERVICE
Mailing Address - Street 2:P.O. BOX 210095
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0001
Mailing Address - Country:US
Mailing Address - Phone:520-621-3334
Mailing Address - Fax:
Practice Address - Street 1:CAPS CAMPUS HEALTH SERVICE
Practice Address - Street 2:1224 E. LOWELL STREET
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:521-621-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC- 12616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional