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General NPI Number Information
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NPI Number | 1134436348
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Entity Type | Organization
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Legal Business Name | DEER VALLEY COUNSELING, INC.
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 03/18/2012
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Provider Practice Location Address
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Address Line | 2301 W DUNLAP AVE SUITE 206
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City | PHOENIX
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State | AZ
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Zip | 85021-2844
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Country | US
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Telephone | 602-750-8705
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 W DUNLAP AVE SUITE 206
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City | PHOENIX
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State | AZ
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Zip | 85021-2844
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Country | US
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Telephone | 602-750-8705
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Fax |
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | JAMES NETTLES
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Credential | MS
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Telephone | 602-750-8705
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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 | LPC-11594
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-13346
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-10782
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License Number State | AZ
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