=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235420357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHARA COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2011
-----------------------------------------------------
Last Update Date | 01/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13820 N 51ST AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85306-4885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-398-8904
-----------------------------------------------------
Fax | 623-414-3448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13820 N 51ST AVE STE 100
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85306-4842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-398-8904
-----------------------------------------------------
Fax | 623-414-3448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATTI L DAVIS
-----------------------------------------------------
Credential | MAPC
-----------------------------------------------------
Telephone | 62339808904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 10498
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 13568
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------