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General NPI Number Information
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NPI Number | 1518747484
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Entity Type | Organization
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Legal Business Name | MOMENTUM COUNSELING SERVICES
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 5902 W CACTUS RD
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City | GLENDALE
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State | AZ
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Zip | 85304-1710
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Country | US
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Telephone | 623-377-4738
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Fax |
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Provider Business Mailing Address
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Address Line | 18450 W BROOKWOOD DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-6476
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALAN KETTERLING
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Credential |
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Telephone | 623-377-4737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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