Basic Information
| Provider Information | |||||||||
| NPI: | 1245367747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMSTOCK | ||||||||
| FirstName: | ANITA | ||||||||
| MiddleName: | LUCERO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | GUIDANCE COUNSELOR K | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 PALMCROFT DR | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285028004 | ||||||||
| FaxNumber: | 9285024445 | ||||||||
| Practice Location | |||||||||
| Address1: | 2851 S AVENUE B BLDG 20 | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853647726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283362434 | ||||||||
| FaxNumber: | 9283362435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 08/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-15552 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.