Provider Demographics
NPI:1245872530
Name:BECERRA, GABRIELA (MSC, LPC)
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:BECERRA
Suffix:
Gender:F
Credentials:MSC, LPC
Other - Prefix:MISS
Other - First Name:GABY
Other - Middle Name:
Other - Last Name:BECERRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSC, LPC
Mailing Address - Street 1:1415 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1604
Mailing Address - Country:US
Mailing Address - Phone:602-595-5447
Mailing Address - Fax:602-595-4537
Practice Address - Street 1:1415 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1604
Practice Address - Country:US
Practice Address - Phone:602-595-5447
Practice Address - Fax:602-595-4537
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional