Healthcare Provider Details

I. General information

NPI: 1154171502
Provider Name (Legal Business Name): FRESH START COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41942 W PALMYRA CT
MARICOPA AZ
85138-3271
US

IV. Provider business mailing address

41942 W PALMYRA CT
MARICOPA AZ
85138-3271
US

V. Phone/Fax

Practice location:
  • Phone: 520-483-8070
  • Fax:
Mailing address:
  • Phone: 520-483-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONNIE L SIMONSON
Title or Position: MARRIAGE & FAMILY THERAPIST
Credential: LMFT
Phone: 520-483-8070