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General NPI Number Information
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NPI Number | 1063600542
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VALLEY COUNSELING ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 145 E UNIVERSITY DR SUITE 6
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City | MESA
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State | AZ
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Zip | 85201-5945
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Country | US
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Telephone | 480-962-7808
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Fax | 480-962-0560
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Provider Business Mailing Address
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Address Line | 145 E UNIVERSITY DR SUITE 6
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City | MESA
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State | AZ
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Zip | 85201-5945
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Country | US
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Telephone | 480-962-7808
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Fax | 480-962-0560
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARCY WILKERSON
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Credential | CPA
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Telephone | 480-962-7808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH-1852
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License Number State | AZ
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