Active NPI
Mylda Carrillo, M.ED, LPC
- Professional Counselor
- Phoenix, AZ
National Provider Identifier
1033656376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-11650
- Practice address
- 11011 S 48TH St Ste 101
Phoenix, AZ 85044-1787 - Phone
- (480) 331-3606
- NPI assigned
- Jan 25, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-11650 | AZ | Primary |
Addresses
Primary practice location
11011 S 48TH St Ste 101
Phoenix, AZ 85044-1787
Mailing address
2850 N 24TH St
Phoenix, AZ 85008-1004
Phone (602) 200-0434
Other practice location 1
2850 N. 24TH St.
Phoenix, AZ 85008
Phone (602) 200-0434
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-11650 | AZ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682035200000",
"number": "1033656376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2850 N 24TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850081004",
"telephone_number": "602-200-0434",
"fax_number": "602-200-0445"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11011 S 48TH ST STE 101",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850441787",
"telephone_number": "480-331-3606"
}
],
"practiceLocations": [
{
"address_1": "2850 N. 24TH ST.",
"address_purpose": "LOCATION",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85008",
"country_code": "US",
"telephone_number": "602-200-0434",
"fax_number": "602-200-0445",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARRILLO",
"first_name": "MYLDA",
"name_prefix": "Mrs.",
"credential": "M.ED, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-25",
"last_updated": "2023-04-21",
"certification_date": "2022-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "LPC-11650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.