Healthcare Provider Details

I. General information

NPI: 1225994742
Provider Name (Legal Business Name): SWEET TEA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 N 15TH ST
PHOENIX AZ
85014-2430
US

IV. Provider business mailing address

6040 N 15TH ST UNIT 42
PHOENIX AZ
85014-2430
US

V. Phone/Fax

Practice location:
  • Phone: 602-456-0894
  • Fax:
Mailing address:
  • Phone: 602-456-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY J KUCERA
Title or Position: THERAPIST
Credential: LPC
Phone: 602-761-0286