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General NPI Number Information
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NPI Number | 1508368986
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Entity Type | Organization
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Legal Business Name | LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 4515 S MCCLINTOCK DR STE 114
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City | TEMPE
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State | AZ
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Zip | 85282-7381
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Country | US
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Telephone | 480-641-1165
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Fax |
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Provider Business Mailing Address
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Address Line | 335 N ALMA SCHOOL RD STE E
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City | CHANDLER
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State | AZ
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Zip | 85224-4363
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Country | US
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Telephone | 480-641-1165
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | JOHN DELORENZO
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Credential |
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Telephone | 480-641-1165
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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 | OTC8596
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License Number State | AZ
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