Healthcare Provider Details

I. General information

NPI: 1750163895
Provider Name (Legal Business Name): STILL RIPPLES COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLTER ST UNIT 202
PHOENIX AZ
85016-3374
US

IV. Provider business mailing address

1701 E COLTER ST UNIT 202
PHOENIX AZ
85016-3374
US

V. Phone/Fax

Practice location:
  • Phone: 480-420-9603
  • Fax: 480-393-7142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONGA THERESE BRYANT
Title or Position: OWNER/AUTHORIZED AGENT
Credential: LPC
Phone: 480-420-9603