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General NPI Number Information
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NPI Number | 1275924482
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Entity Type | Organization
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Legal Business Name | CRESTVIEW CHILD COUNSELING, LLC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 01/25/2021
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Provider Practice Location Address
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Address Line | 9855 S PRIEST DR STE 102
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City | TEMPE
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State | AZ
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Zip | 85284-3605
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Country | US
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Telephone | 480-616-4141
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11373
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City | CHANDLER
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State | AZ
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Zip | 85248-0007
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Country | US
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Telephone | 480-616-4141
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | DR. LIZ PLOTKIN
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Credential | PHD
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Telephone | 480-616-4141
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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-13990
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License Number State | AZ
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