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General NPI Number Information
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NPI Number | 1134388358
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Entity Type | Organization
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Legal Business Name | HEALING CONNECTIONS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 333 W WILCOX DR SUITE 303
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1756
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Country | US
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Telephone | 520-378-2613
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Fax | 520-458-5124
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Provider Business Mailing Address
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Address Line | 333 W WILCOX DR SUITE 303
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-1756
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Country | US
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Telephone | 520-378-2613
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Fax | 520-458-5124
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Authorized Official
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Title or Position | DIRECTOR/ COUNSELOR
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Name | MR. WILLIS JEROME BEASLEY
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Credential | M.C.,L.P.C.,N.C.C.
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Telephone | 520-378-2613
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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 | LPC10904
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License Number State | AZ
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