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General NPI Number Information
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NPI Number | 1487169009
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Entity Type | Organization
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Legal Business Name | RESTORATIVE HEALING AND COUNSELING CENTER LLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 9855 S. PRIEST DRIVE SUITE 102
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City | TEMPE
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State | AZ
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Zip | 85284
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Country | US
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Telephone | 480-788-1009
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Fax |
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Provider Business Mailing 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 | 480-788-1009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLEYA KIM
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Credential | MS LMFT
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Telephone | 480-788-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 15218
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License Number State | AZ
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