Provider Demographics
NPI: | 1407589690 |
---|---|
Name: | MURILLO, LADIS |
Entity Type: | Individual |
Prefix: | |
First Name: | LADIS |
Middle Name: | |
Last Name: | MURILLO |
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: | 4355 E UNIVERSITY DR STE 108 |
Mailing Address - Street 2: | |
Mailing Address - City: | MESA |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85205-7000 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 480-578-2971 |
Mailing Address - Fax: | 480-907-2365 |
Practice Address - Street 1: | 4355 E UNIVERSITY DR STE 108 |
Practice Address - Street 2: | |
Practice Address - City: | MESA |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85205 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-578-2971 |
Practice Address - Fax: | 480-907-2365 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2022-07-05 |
Last Update Date: | 2023-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | ||
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | ||
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | ||
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |