=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285599332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNTANGLED WEB COUNSELING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2025
-----------------------------------------------------
Last Update Date | 12/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4824 E BASELINE RD STE 124
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85206-4679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-351-5108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3324 E RAY RD UNIT 1242
-----------------------------------------------------
City | HIGLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85236-4558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-351-5108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MBR
-----------------------------------------------------
Name | DANICA BRAZAITIS
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 610-703-4525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------