Healthcare Provider Details

I. General information

NPI: 1144837881
Provider Name (Legal Business Name): PHOENIX COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W BASELINE RD STE 116
PHOENIX AZ
85041-6400
US

IV. Provider business mailing address

2030 W BASELINE RD STE 182411
PHOENIX AZ
85041-6574
US

V. Phone/Fax

Practice location:
  • Phone: 602-899-2634
  • Fax:
Mailing address:
  • Phone: 602-899-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHIKO PEPPLE
Title or Position: OWNER
Credential:
Phone: 602-899-2534