Basic Information
| Provider Information | |||||||||
| NPI: | 1952766149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALDROP | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2730 S VAL VISTA DR | ||||||||
| Address2: | SUITES 146 & 137 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852951675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804718560 | ||||||||
| FaxNumber: | 8889798197 | ||||||||
| Practice Location | |||||||||
| Address1: | 2730 S VAL VISTA DR | ||||||||
| Address2: | SUITES 146 & 137 | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852951675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804718560 | ||||||||
| FaxNumber: | 8889798197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2015 | ||||||||
| LastUpdateDate: | 12/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC-15412 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.