Provider Demographics
NPI:1376303214
Name:GUADALUPE, LUCY (MFT)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:GUADALUPE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8068 E VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-1735
Mailing Address - Country:US
Mailing Address - Phone:425-890-2270
Mailing Address - Fax:
Practice Address - Street 1:9260 E RAINTREE DR STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7310
Practice Address - Country:US
Practice Address - Phone:425-890-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-08043T106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist