Healthcare Provider Details

I. General information

NPI: 1316458169
Provider Name (Legal Business Name): JPM COUNSELING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8149 N 87TH PL
SCOTTSDALE AZ
85258-4399
US

IV. Provider business mailing address

8149 N 87TH PL
SCOTTSDALE AZ
85258-4399
US

V. Phone/Fax

Practice location:
  • Phone: 602-909-8409
  • Fax:
Mailing address:
  • Phone: 602-909-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-13258
License Number StateAZ

VIII. Authorized Official

Name: JASON MOORE
Title or Position: CREDENTIALS
Credential:
Phone: 602-400-0800