Provider Demographics
NPI:1982215521
Name:PARADA, ISABELLA (MA, LAC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:
Last Name:PARADA
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:MS
Other - First Name:ISABELLA
Other - Middle Name:DOLORES
Other - Last Name:VENTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3383 E SILVERSMITH TRL
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-3362
Mailing Address - Country:US
Mailing Address - Phone:602-291-0703
Mailing Address - Fax:
Practice Address - Street 1:2111 E BASELINE RD STE C3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1521
Practice Address - Country:US
Practice Address - Phone:480-233-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-18896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty