Healthcare Provider Details

I. General information

NPI: 1972326973
Provider Name (Legal Business Name): DK COUNSELING AND CLINICAL SUPERVISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 W KELTON LN BLDG B3
PEORIA AZ
85382-3584
US

IV. Provider business mailing address

17421 N 85TH DR
PEORIA AZ
85382-8026
US

V. Phone/Fax

Practice location:
  • Phone: 602-613-0403
  • Fax:
Mailing address:
  • Phone: 602-613-0403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL KAPELLE
Title or Position: DIRECTOR
Credential: LCSW
Phone: 602-613-0403