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General NPI Number Information
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NPI Number | 1700754116
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Entity Type | Organization
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Legal Business Name | EVENTIDE COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 18001 N 79TH AVE STE A10
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City | GLENDALE
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State | AZ
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Zip | 85308-8389
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Country | US
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Telephone | 623-278-5440
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Fax | 623-278-5440
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Provider Business Mailing Address
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Address Line | 18001 N 79TH AVE STE A10
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City | GLENDALE
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State | AZ
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Zip | 85308-8389
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Country | US
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Telephone | 623-278-5440
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Fax | 623-278-5440
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Authorized Official
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Title or Position | OWNER- MENTAL HEALTH COUNSELING
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Name | THUY THU TRAN
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Credential | LPC
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Telephone | 623-239-8550
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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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