Provider Demographics
NPI:1942296348
Name:IANNELLO, LOURDES M (MC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:M
Last Name:IANNELLO
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N GREENWOOD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7544
Mailing Address - Country:US
Mailing Address - Phone:602-578-5682
Mailing Address - Fax:480-355-4101
Practice Address - Street 1:7165 E UNIVERSITY DR
Practice Address - Street 2:SUITE 188-1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6400
Practice Address - Country:US
Practice Address - Phone:602-578-5682
Practice Address - Fax:480-355-4101
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 11743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional