Healthcare Provider Details

I. General information

NPI: 1740248715
Provider Name (Legal Business Name): VALLEY COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W COTTONWOOD LN SUITE 1
CASA GRANDE AZ
85122-2247
US

IV. Provider business mailing address

PO BOX 172
MARICOPA AZ
85139-0049
US

V. Phone/Fax

Practice location:
  • Phone: 520-424-1100
  • Fax:
Mailing address:
  • Phone: 928-274-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3917
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6880
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1154
License Number StateAZ

VIII. Authorized Official

Name: DR. CATHY LYNN BISSETT
Title or Position: PSYCHOLOGIST
Credential: PSYD, MBA
Phone: 928-274-0294