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General NPI Number Information
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NPI Number | 1609142421
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Entity Type | Organization
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Legal Business Name | ARIZONA COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 5418 E SKYLINE DR BLDG 1
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-9000
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Country | US
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Telephone | 480-818-7117
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Fax | 480-987-9252
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Provider Business Mailing Address
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Address Line | 270 E HUNT HWY SUITE 16, PMB 144
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85143-4962
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Country | US
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Telephone | 480-818-7117
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Fax | 480-987-9252
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | MS. NICOLE LEA LORE
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Credential | LCSW
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Telephone | 480-818-7117
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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 | LCSW-12587
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License Number State | AZ
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