Healthcare Provider Details

I. General information

NPI: 1225430093
Provider Name (Legal Business Name): SONORAN SAGE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 E VALLEY AUTO DR STE 201
MESA AZ
85206-4605
US

IV. Provider business mailing address

3296 E HOPKINS RD
GILBERT AZ
85295-2115
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-0107
  • Fax:
Mailing address:
  • Phone: 602-456-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-15171
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JULIE MCALLISTER
Title or Position: OWNER/THERAPIST
Credential: LPC, NCC
Phone: 602-456-0107