Provider Demographics
NPI:1740432244
Name:MACIAS, PRISCILLA (MC)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71743
Mailing Address - Street 2:138 W. MONONA DRIVE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1013
Mailing Address - Country:US
Mailing Address - Phone:480-840-5702
Mailing Address - Fax:
Practice Address - Street 1:138 W MONONA DR
Practice Address - Street 2:14432 S. 43RD STREET, PHOENIX, AZ. 85044
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5962
Practice Address - Country:US
Practice Address - Phone:480-840-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor