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General NPI Number Information
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NPI Number | 1053835843
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Entity Type | Organization
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Legal Business Name | UNITED STATES VETERANS INITIATIVE - PRESCOTT
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 917 E GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-583-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 917 E GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-583-7678
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CAROLE BENEDICT
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Credential |
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Telephone | 928-583-7678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-16532
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-15394
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC-13141
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License Number State | AZ
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