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General NPI Number Information
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NPI Number | 1124342993
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Entity Type | Organization
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Legal Business Name | MENDING HEARTS FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 17431 N. 71ST DR. SUITE 103
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-633-2246
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Fax | 602-687-7069
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Provider Business Mailing Address
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Address Line | 17431 N. 71ST DR. SUITE 103
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-633-2246
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Fax | 602-687-7069
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. SHARON ANN CARL
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Credential | MA, M. ED., LPC
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Telephone | 602-633-2246
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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 | LPC - 1003
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License Number State | AZ
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