Healthcare Provider Details

I. General information

NPI: 1659936680
Provider Name (Legal Business Name): SEDONA FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CASTLE ROCK RD UNIT 65
SEDONA AZ
86351-8876
US

IV. Provider business mailing address

2860 DRISTOL DR
COLORADO SPRINGS CO
80920-5110
US

V. Phone/Fax

Practice location:
  • Phone: 505-974-1358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY CHISHOLM
Title or Position: PRESIDENT
Credential:
Phone: 505-974-1358