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General NPI Number Information
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NPI Number | 1033441514
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Entity Type | Organization
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Legal Business Name | QUEEN CREEK COUNSELING LLC
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 21321 E OCOTILLO RD B-105
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5996
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Country | US
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Telephone | 480-258-2915
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Fax | 480-888-0231
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-1835
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Country | US
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Telephone | 480-258-2915
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Fax | 480-888-0231
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Authorized Official
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Title or Position | OWNER
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Name | PAMELA CAROL DEAN
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Credential | LCSW
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Telephone | 480-258-2915
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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-2854
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License Number State | AZ
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