Healthcare Provider Details

I. General information

NPI: 1043460397
Provider Name (Legal Business Name): SAN TAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 07/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 N IRONWOOD DR STE 101
APACHE JUNCTION AZ
85220-3830
US

IV. Provider business mailing address

288 N IRONWOOD DR
APACHE JUNCTION AZ
85220-3830
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-2356
  • Fax: 480-982-2449
Mailing address:
  • Phone: 480-982-2356
  • Fax: 480-982-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name: D PAUL SMITH
Title or Position: CEO
Credential:
Phone: 801-292-3131