Provider Demographics
NPI:1417640657
Name:ASADA, MARIKO (LPC)
Entity Type:Individual
Prefix:
First Name:MARIKO
Middle Name:
Last Name:ASADA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 E SHEA BLVD APT 2068
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5746
Mailing Address - Country:US
Mailing Address - Phone:480-270-1762
Mailing Address - Fax:
Practice Address - Street 1:3001 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3060
Practice Address - Country:US
Practice Address - Phone:602-353-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional