Provider Demographics
NPI:1437234325
Name:GEGENHEIMER, CAROL ANN (PHD, LISAC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:GEGENHEIMER
Suffix:
Gender:F
Credentials:PHD, LISAC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 N 67TH AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3698
Mailing Address - Country:US
Mailing Address - Phone:602-938-3323
Mailing Address - Fax:602-938-1626
Practice Address - Street 1:17100 N 67TH AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3698
Practice Address - Country:US
Practice Address - Phone:602-938-3323
Practice Address - Fax:602-938-1626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10198101YA0400X
AZLMFT-10101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)