Healthcare Provider Details

I. General information

NPI: 1164768313
Provider Name (Legal Business Name): JFM INSPIRATIONS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4119 N MITCHELL ST
PHOENIX AZ
85014-4815
US

IV. Provider business mailing address

4119 N MITCHELL ST
PHOENIX AZ
85014-4815
US

V. Phone/Fax

Practice location:
  • Phone: 602-374-2299
  • Fax: 602-374-2299
Mailing address:
  • Phone: 602-374-2299
  • Fax: 602-374-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberBH4141
License Number StateAZ

VIII. Authorized Official

Name: ALISA J FURCH
Title or Position: CLINICAL COORDINATOR
Credential: LPC
Phone: 602-299-3545