Provider Demographics
NPI:1548704497
Name:PRILLWITZ, ROXANNE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:LYNN
Last Name:PRILLWITZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E BLACKLIDGE DR
Mailing Address - Street 2:#828
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2772
Mailing Address - Country:US
Mailing Address - Phone:520-203-2953
Mailing Address - Fax:
Practice Address - Street 1:2435 N CASTRO AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5060
Practice Address - Country:US
Practice Address - Phone:520-622-8030
Practice Address - Fax:520-622-8012
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional