Provider Demographics
NPI:1700615788
Name:MAESTAS, LORI (LAC,NCC,MA)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:LAC,NCC,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S BURRO CANYON PL
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-7938
Mailing Address - Country:US
Mailing Address - Phone:520-955-9711
Mailing Address - Fax:
Practice Address - Street 1:3131 E 2ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-4209
Practice Address - Country:US
Practice Address - Phone:520-955-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22955101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor