Provider Demographics
NPI:1437876992
Name:APPLETON, ROBERTA (LAC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:APPLETON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N CENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6733
Mailing Address - Country:US
Mailing Address - Phone:480-527-0337
Mailing Address - Fax:480-452-1311
Practice Address - Street 1:303 N CENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6733
Practice Address - Country:US
Practice Address - Phone:480-527-0337
Practice Address - Fax:480-452-1311
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17650101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor