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General NPI Number Information
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NPI Number | 1013362474
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Entity Type | Organization
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Legal Business Name | VAIL COUNSELING LLC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 14600 E COLOSSAL CAVE RD
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City | VAIL
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State | AZ
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Zip | 85641-6173
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Country | US
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Telephone | 520-474-5574
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Fax |
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Provider Business Mailing Address
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Address Line | 10792 S BLACK CACTUS TRL
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City | VAIL
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State | AZ
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Zip | 85641-6463
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Country | US
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Telephone | 520-474-5574
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA STEELE
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Credential | MSW, LCSW
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Telephone | 520-474-5574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-16051
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License Number State | AZ
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