Provider Demographics
NPI:1912310913
Name:ROSSI, JOSETTE (BA LISAC BHP)
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:
Last Name:ROSSI
Suffix:
Gender:F
Credentials:BA LISAC BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-0033
Mailing Address - Country:US
Mailing Address - Phone:520-414-6257
Mailing Address - Fax:
Practice Address - Street 1:556 SOUTH ARIZONA AVE.
Practice Address - Street 2:PINAL HISPANIC COUNCIL
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128
Practice Address - Country:US
Practice Address - Phone:520-723-7405
Practice Address - Fax:520-723-7410
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC#-11613101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)