Healthcare Provider Details

I. General information

NPI: 1891089504
Provider Name (Legal Business Name): IRONWOOD COUNSELING AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 S POWER RD
GILBERT AZ
85297-9281
US

IV. Provider business mailing address

1110 E CHELSEA DR
SAN TAN VALLEY AZ
85140-5661
US

V. Phone/Fax

Practice location:
  • Phone: 602-573-5351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3930
License Number StateAZ

VIII. Authorized Official

Name: JARED DINEHART
Title or Position: OWNER
Credential: PH.D.
Phone: 602-573-5351