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General NPI Number Information
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NPI Number | 1154767291
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Entity Type | Organization
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Legal Business Name | MINDFUL MOUNTAIN COUNSELING, P.L.L.C.
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE STE. 311C
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City | GLENDALE
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State | AZ
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Zip | 85308-8725
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Country | US
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Telephone | 623-692-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 17505 N 79TH AVE STE. 311C
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City | GLENDALE
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State | AZ
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Zip | 85308-8725
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Country | US
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Telephone | 623-692-4311
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Fax |
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Authorized Official
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Title or Position | OWNER, MANAGER
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Name | LAURA ELMA HUBER
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Credential | LPC
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Telephone | 623-692-4311
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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-14028
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License Number State | AZ
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