Provider Demographics
NPI:1376626721
Name:ULLRICH, CAROL ANNE
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANNE
Last Name:ULLRICH
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 1:5658 S CALLE METATE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9063
Mailing Address - Country:US
Mailing Address - Phone:520-661-4535
Mailing Address - Fax:520-417-2042
Practice Address - Street 1:5658 S CALLE METATE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9063
Practice Address - Country:US
Practice Address - Phone:520-661-4535
Practice Address - Fax:520-417-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 2230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional