Provider Demographics
NPI:1629726161
Name:TRICHILO, DENISE A (MA, LAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:TRICHILO
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12133 W BELL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9408
Mailing Address - Country:US
Mailing Address - Phone:633-875-2919
Mailing Address - Fax:
Practice Address - Street 1:12133 W BELL RD STE 201
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9408
Practice Address - Country:US
Practice Address - Phone:623-875-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-15246101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor