Provider Demographics
NPI:1972161982
Name:OJALA, JAQUELINE MARIA FALLON (MC, LISAC, LAC)
Entity Type:Individual
Prefix:MRS
First Name:JAQUELINE
Middle Name:MARIA FALLON
Last Name:OJALA
Suffix:
Gender:F
Credentials:MC, LISAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-1213
Mailing Address - Country:US
Mailing Address - Phone:623-344-2861
Mailing Address - Fax:
Practice Address - Street 1:6015 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1213
Practice Address - Country:US
Practice Address - Phone:623-344-2861
Practice Address - Fax:623-344-4449
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor