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General NPI Number Information
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NPI Number | 1194102582
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Entity Type | Organization
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Legal Business Name | SPANE COUNSELING
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 810 N 6TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85003-1318
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Country | US
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Telephone | 602-234-0541
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Fax | 602-462-1119
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Provider Business Mailing Address
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Address Line | 810 N 6TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85003-1318
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Country | US
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Telephone | 602-234-0541
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Fax | 602-462-1119
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | CELESTE SPANE
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Credential | LPC
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Telephone | 602-234-0541
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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-0716
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License Number State | AZ
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