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General NPI Number Information
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NPI Number | 1194592824
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Entity Type | Organization
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Legal Business Name | PREMIER TRAUMA COUNSELING LLC
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 4540 E BASELINE RD STE 105
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City | MESA
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State | AZ
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Zip | 85206-4616
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Country | US
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Telephone | 480-272-8944
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Fax |
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Provider Business Mailing Address
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Address Line | 4540 E BASELINE RD STE 105
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City | MESA
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State | AZ
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Zip | 85206-4616
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Country | US
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Telephone | 480-272-8944
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JAMES SIEFFERT
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Credential | DC
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Telephone | 480-272-8944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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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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