1609142421 NPI number — ARIZONA COUNSELING SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609142421 NPI number — ARIZONA COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA 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:
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:
1609142421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 E HUNT HWY
Provider Second Line Business Mailing Address:
SUITE 16, PMB 144
Provider Business Mailing Address City Name:
SAN TAN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85143-4962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-818-7117
Provider Business Mailing Address Fax Number:
480-987-9252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5418 E SKYLINE DR BLDG 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN TAN VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85140-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-818-7117
Provider Business Practice Location Address Fax Number:
480-987-9252
Provider Enumeration Date:
03/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LORE
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
OWNER/ THERAPIST
Authorized Official Telephone Number:
480-818-7117

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LCSW-12587 , 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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