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General NPI Number Information
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NPI Number | 1295377687
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Entity Type | Organization
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Legal Business Name | SERENITY PRESERVED COUNSELING PLLC
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 21448 N. 75TH AVENUE STE G
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City | GLENDALE
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State | AZ
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Zip | 85308
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Country | US
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Telephone | 602-596-1127
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Fax | 855-874-0967
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Provider Business Mailing Address
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Address Line | 19141 N. 84TH ST
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City | PEONA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 602-391-0512
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. PAUL EDWARD BLEIKAMP
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Credential | LPC
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Telephone | 602-391-0512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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