MEDICARE: CORONADO COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-15259	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	959577	OTHER	AZ	ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM

General Provider Information

NPI Number	:	1124499249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORONADO COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	7414 E CAMELBACK RD STE 103
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3509
Country	:	US
Telephone Number	:	520-370-4731
Fax Number	:

Provider Business Practice Location Address
First Line	:	7414 E CAMELBACK RD STE 103
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-3509
Country	:	US
Telephone Number	:	520-370-4731
Fax Number	:

Authorized Official
Title or Position	:	OWNER/COUNSELOR
Name	:	MELISSA CORONADO
Credential	:	LPC
Telephone Number	:	520-370-4731

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/18/2016

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