Healthcare Provider Details

I. General information

NPI: 1902206246
Provider Name (Legal Business Name): SENIOR COUNSELING SERVICES OF ARIZONA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 E VALLEY AUTO DR STE 201
MESA AZ
85206-4609
US

IV. Provider business mailing address

4111 E VALLEY AUTO DR STE 201
MESA AZ
85206-4609
US

V. Phone/Fax

Practice location:
  • Phone: 480-745-5552
  • Fax:
Mailing address:
  • Phone: 480-745-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13046
License Number StateAZ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. ALAN NESBIT
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 480-745-5552