Provider Demographics
NPI:1396571550
Name:SISO, SINDISO L (LPC)
Entity type:Individual
Prefix:
First Name:SINDISO
Middle Name:L
Last Name:SISO
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 1:1901 N TREKELL RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1770
Mailing Address - Country:US
Mailing Address - Phone:520-836-1029
Mailing Address - Fax:520-836-6733
Practice Address - Street 1:1901 N TREKELL RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1770
Practice Address - Country:US
Practice Address - Phone:520-836-1029
Practice Address - Fax:520-836-6733
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional