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General NPI Number Information
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NPI Number | 1164087391
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Entity Type | Organization
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Legal Business Name | MENTAL MENDING COUNSELING
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 1680 W IRON SPRINGS RD STE 103
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City | PRESCOTT
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State | AZ
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Zip | 86305-3313
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Country | US
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Telephone | 928-899-0251
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1037
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City | WASHOUGAL
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State | WA
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Zip | 98671-0923
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TERENCE MAGUIRE PILICY
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Credential | MA, LPC
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Telephone | 928-899-0251
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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 |
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License Number State |
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