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General NPI Number Information
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NPI Number | 1194186312
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Entity Type | Organization
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Legal Business Name | MOUNTAIN RIDGE COUNSELING
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE SUITE 213-E
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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 | 623-695-4704
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Fax |
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Provider Business Mailing Address
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Address Line | 17505 N 79TH AVE SUITE 213-E
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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 | 623-695-4704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RYAN TAYLOR
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Credential |
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Telephone | 602-228-1108
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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 | CSLG7595
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License Number State | AZ
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