Provider Demographics
NPI:1821238866
Name:GUPTA, PALLAVI S (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PALLAVI
Middle Name:S
Last Name:GUPTA
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 1:12450 N RANCHO VISTOSO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-9567
Mailing Address - Country:US
Mailing Address - Phone:520-661-4302
Mailing Address - Fax:
Practice Address - Street 1:12450 N RANCHO VISTOSO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-9567
Practice Address - Country:US
Practice Address - Phone:520-661-4302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10682101YA0400X
AZLPC11968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)