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NPI Code Detail

MEDICARE: CONFIDENTIAL COUNSELING & CONSULTING LLC

MEDICARE: CONFIDENTIAL COUNSELING & CONSULTING LLC
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
1101Y00000XCounselor
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1992225189
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONFIDENTIAL COUNSELING & CONSULTING LLC
Provider Business Mailing Address
First Line : PO BOX 6346
Second Line :
City : CHANDLER
State : AZ
Zip : 85246-6346
Country : US
Telephone Number : 336-392-7099
Fax Number :
Provider Business Practice Location Address
First Line : 10201 S 51ST ST STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-5226
Country : US
Telephone Number : 336-392-7099
Fax Number :
Authorized Official
Title or Position : OWNER
Name : TYRA DAVENPORT
Credential :
Telephone Number : 336-392-7099
Provider Enumeration Date : 06/20/2017
Last Update Date : 03/17/2018

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Directions to “CONFIDENTIAL COUNSELING & CONSULTING LLC ” Practice Location

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