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General NPI Number Information
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NPI Number | 1548420557
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Entity Type | Organization
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Legal Business Name | PRACTICAL LIFE COUNSELING, PLLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 331 S COOPER RD
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City | GILBERT
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State | AZ
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Zip | 85233-6201
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Country | US
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Telephone | 602-341-8241
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Fax |
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Provider Business Mailing Address
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Address Line | 2023 E LODGE DR
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City | TEMPE
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State | AZ
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Zip | 85283-3355
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Country | US
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Telephone | 602-341-8241
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | TINA MARIE REES
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Credential | MA, LPC
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Telephone | 602-341-8241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | LPC12937
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License Number State | AZ
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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 | LPC-12937
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License Number State | AZ
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