Healthcare Provider Details

I. General information

NPI: 1548420557
Provider Name (Legal Business Name): PRACTICAL LIFE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 S COOPER RD
GILBERT AZ
85233-6201
US

IV. Provider business mailing address

2023 E LODGE DR
TEMPE AZ
85283-3355
US

V. Phone/Fax

Practice location:
  • Phone: 602-341-8241
  • Fax:
Mailing address:
  • Phone: 602-341-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLPC12937
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-12937
License Number StateAZ

VIII. Authorized Official

Name: TINA MARIE REES
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 602-341-8241