MEDICARE: PARK PLACE OUTREACH AND COUNSELING INC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1821001504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK PLACE OUTREACH AND COUNSELING INC

Provider Business Mailing Address
First Line	:	PO BOX 2779
Second Line	:	9373 W BATTAGLIA RD
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85223-2779
Country	:	US
Telephone Number	:	520-466-8850
Fax Number	:	520-466-8851

Provider Business Practice Location Address
First Line	:	9373 W BATTAGLIA RD
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85223-2779
Country	:	US
Telephone Number	:	520-466-8850
Fax Number	:	520-466-8851

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. RAYMOND LINAFEITER
Credential	:
Telephone Number	:	520-466-8850

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/22/2020

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