Healthcare Provider Details

I. General information

NPI: 1023953122
Provider Name (Legal Business Name): LIVING WATER: WHITE MOUNTAIN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S RIDGE DR
SHOW LOW AZ
85901-5293
US

IV. Provider business mailing address

540 S RIDGE DR
SHOW LOW AZ
85901-5293
US

V. Phone/Fax

Practice location:
  • Phone: 908-418-1765
  • Fax:
Mailing address:
  • Phone: 908-418-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CINDI CLARICE KUTSOP
Title or Position: LICENSED INDEPENDENT ADDICTION COUN
Credential: LIAC
Phone: 908-418-1765