Healthcare Provider Details

I. General information

NPI: 1912943903
Provider Name (Legal Business Name): NORTHLIGHT COUNSELING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 E VALLEY AUTO DR SUITE 122
MESA AZ
85206-4631
US

IV. Provider business mailing address

4121 E VALLEY AUTO DR. SUITE 122
MESA AZ
85206-4631
US

V. Phone/Fax

Practice location:
  • Phone: 602-285-9696
  • Fax: 602-277-5930
Mailing address:
  • Phone: 602-285-9696
  • Fax: 602-277-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: STACY CLOYD
Title or Position: SECRETARY
Credential:
Phone: 904-605-4986