Provider Demographics
NPI:1033867387
Name:GRULLER, AMBER ANA
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ANA
Last Name:GRULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:ANA
Other - Last Name:GRAFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3673 E BAKER PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5014
Mailing Address - Country:US
Mailing Address - Phone:520-808-8780
Mailing Address - Fax:
Practice Address - Street 1:145 E UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7738
Practice Address - Country:US
Practice Address - Phone:520-808-8780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty