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General NPI Number Information
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NPI Number | 1659936680
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Entity Type | Organization
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Legal Business Name | SEDONA FAMILY COUNSELING
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 130 CASTLE ROCK RD UNIT 65
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City | SEDONA
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State | AZ
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Zip | 86351-8876
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Country | US
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Telephone | 505-974-1358
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Fax |
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Provider Business Mailing Address
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Address Line | 2860 DRISTOL DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-5110
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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 | PRESIDENT
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Name | KELLY CHISHOLM
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Credential |
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Telephone | 505-974-1358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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