Provider Demographics
NPI:1346027901
Name:CIMENTAL, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CIMENTAL
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 1:3422 E MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6236
Mailing Address - Country:US
Mailing Address - Phone:602-350-1433
Mailing Address - Fax:
Practice Address - Street 1:3422 E MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6236
Practice Address - Country:US
Practice Address - Phone:602-350-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22243101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor