1134388358 NPI number — HEALING CONNECTIONS COUNSELING SERVICES, LLC

Table of content: DR. AMBROSIO JESUS ROMERO M.D., F.A.A.F.P. (NPI 1588635759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134388358 NPI number — HEALING CONNECTIONS COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING CONNECTIONS COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134388358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W WILCOX DR
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
SIERRA VISTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85635-1756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-378-2613
Provider Business Mailing Address Fax Number:
520-458-5124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W WILCOX DR
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
SIERRA VISTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85635-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-378-2613
Provider Business Practice Location Address Fax Number:
520-458-5124
Provider Enumeration Date:
06/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BEASLEY
Authorized Official First Name:
WILLIS
Authorized Official Middle Name:
JEROME
Authorized Official Title or Position:
DIRECTOR/ COUNSELOR
Authorized Official Telephone Number:
520-378-2613

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC10904 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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