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General NPI Number Information
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NPI Number | 1033356738
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 01/16/2009
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Provider Practice Location Address
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Address Line | 8183 E FLORENTINE RD SUITE B
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-8454
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Country | US
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Telephone | 928-772-3499
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Fax | 928-772-3491
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Provider Business Mailing Address
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Address Line | PO BOX 27949
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86312-7949
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Country | US
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Telephone | 928-772-3499
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Fax | 928-772-3491
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | JOHANNA GABRIEL BURTON
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Credential | M.A.
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Telephone | 928-772-3499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC0410
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License Number State | AZ
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