Individual provider Active NPI

Marta Fraser, LAC

  • Professional Counselor
  • Glendale, AZ
National Provider Identifier
1386310118
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC-22794 Issued in AZ
Practice address
4425 W Olive Ave Ste 301
Glendale, AZ 85302-3851
Phone
(623) 267-1776
NPI assigned
Aug 20, 2021
Last updated
Nov 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC-22794 AZ Primary

Addresses

Primary practice location

4425 W Olive Ave Ste 301
Glendale, AZ 85302-3851

Mailing address

10823 W Ruth Ave
Peoria, AZ 85345-2925

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241202002171 AZ Practitioner - Mental Health Counselor 4385179266 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LPC-22794AZMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Acs Medical Transportation LLC CurrentSince Jun 30, 2024 Accepting new patients
Arise Community Solutions Inc Professional CurrentSince Sep 1, 2024 Accepting new patients

Locations

13980 N 67th Ave
Ste 1
Glendale, AZ 85306
Phone (623) 755-9690

4425 W Olive Ave
Ste 301
Glendale, AZ 85302
Phone (623) 267-1776

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1386310118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10823 W RUTH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853452925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 W OLIVE AVE STE 301",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853023851",
            "telephone_number": "623-267-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRASER",
        "first_name": "MARTA",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-20",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC-22794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.