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General NPI Number Information
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NPI Number | 1720313687
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Entity Type | Organization
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Legal Business Name | DEER VALLEY COUNSELING
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Dates
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Enumeration Date | 10/11/2009
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Last Update Date | 10/11/2009
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Provider Practice Location Address
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Address Line | 2301 W DUNLAP AVE SUITE 206
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City | PHOENIX
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State | AZ
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Zip | 85021-2844
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Country | US
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Telephone | 602-750-8051
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Fax | 602-674-5701
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Provider Business Mailing Address
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Address Line | 2301 W DUNLAP AVE SUITE 206
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City | PHOENIX
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State | AZ
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Zip | 85021-2844
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Country | US
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Telephone | 602-750-8051
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Fax | 602-674-5701
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | JAMES LANGLEY NETTLES
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Credential | MS
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Telephone | 602-750-8051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LCSW-10782
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License Number State | AZ
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