Provider Demographics
NPI:1912664673
Name:ABOUCHAR, ALBERTINA OYUELA (MC, NCC, LAC)
Entity Type:Individual
Prefix:
First Name:ALBERTINA
Middle Name:OYUELA
Last Name:ABOUCHAR
Suffix:
Gender:F
Credentials:MC, NCC, LAC
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 24675
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85285-4675
Mailing Address - Country:US
Mailing Address - Phone:480-678-1001
Mailing Address - Fax:
Practice Address - Street 1:401 W BASELINE RD STE 201
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5397
Practice Address - Country:US
Practice Address - Phone:480-307-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health