Provider Demographics
NPI:1235861402
Name:SALAZAR, CODY A (MPSY, CTSS)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:A
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MPSY, CTSS
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:A
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPSY, CTSS
Mailing Address - Street 1:2197 S 4TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6473
Mailing Address - Country:US
Mailing Address - Phone:928-920-6220
Mailing Address - Fax:928-259-7272
Practice Address - Street 1:2197 S 4TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6473
Practice Address - Country:US
Practice Address - Phone:928-920-6220
Practice Address - Fax:928-259-7272
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health