Provider Demographics
NPI:1194190694
Name:ROUMBOS, BERNADETTE (LPC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:ROUMBOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 E PIMA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3074
Mailing Address - Country:US
Mailing Address - Phone:602-644-1142
Mailing Address - Fax:520-344-7687
Practice Address - Street 1:6280 E PIMA ST STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3074
Practice Address - Country:US
Practice Address - Phone:602-644-1142
Practice Address - Fax:520-344-7687
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
AZLPC-18186133V00000X
AZLPC18186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ763872Medicaid