Healthcare Provider Details

I. General information

NPI: 1801431952
Provider Name (Legal Business Name): REDEMPTION COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N WEST ST
FLAGSTAFF AZ
86004-3444
US

IV. Provider business mailing address

3009 N WEST ST
FLAGSTAFF AZ
86004-3444
US

V. Phone/Fax

Practice location:
  • Phone: 928-719-4009
  • Fax:
Mailing address:
  • Phone: 928-719-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EMILY BAUERLE
Title or Position: COUNSELOR
Credential:
Phone: 928-814-8607