Provider Demographics
NPI:1700450772
Name:MURILLO, JUAN, JR (LPC)
Entity Type:Individual
Prefix:
First Name:JUAN, JR
Middle Name:
Last Name:MURILLO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23380 N 61ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5748
Mailing Address - Country:US
Mailing Address - Phone:602-503-0710
Mailing Address - Fax:
Practice Address - Street 1:14040 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6117
Practice Address - Country:US
Practice Address - Phone:602-503-0710
Practice Address - Fax:602-429-8602
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-20180OtherSTATE OF ARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS