Basic Information
| Provider Information | |||||||||
| NPI: | 1962691295 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIJALVA | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | ALICIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 W SAINT MARYS RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206288287 | ||||||||
| FaxNumber: | 5206288749 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 W SAINT MARYS RD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206288287 | ||||||||
| FaxNumber: | 5206288749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.