Healthcare Provider Details

I. General information

NPI: 1194102582
Provider Name (Legal Business Name): SPANE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 6TH AVE
PHOENIX AZ
85003-1318
US

IV. Provider business mailing address

810 N 6TH AVE
PHOENIX AZ
85003-1318
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-0541
  • Fax: 602-462-1119
Mailing address:
  • Phone: 602-234-0541
  • Fax: 602-462-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-0716
License Number StateAZ

VIII. Authorized Official

Name: CELESTE SPANE
Title or Position: OWNER/DIRECTOR
Credential: LPC
Phone: 602-234-0541