Laurel Rettle, LPC, LISAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC1824 Issued in AZ

Practice address

4150 E Harvard Ave
Gilbert, AZ 85234-7562

Phone

(480) 330-7997

NPI assigned

Jun 10, 2014

Last updated

Jun 10, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1821401514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 E HARVARD AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852347562",
            "telephone_number": "480-330-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 E HARVARD AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852347562",
            "telephone_number": "480-330-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTLE",
        "first_name": "LAUREL",
        "credential": "LPC, LISAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": "SA0505",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AZ",
            "license": "LPC1824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Reviving Wellness LLC

• Professional Counselor in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Professional Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.