Basic Information
| Provider Information | |||||||||
| NPI: | 1366586927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | CLARIVEL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5199 | ||||||||
| Address2: | |||||||||
| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796085199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3254378300 | ||||||||
| FaxNumber: | 3254378335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 S FOREST AVE # 334 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852871012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809656147 | ||||||||
| FaxNumber: | 4809653426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-12034 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.