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General NPI Number Information
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NPI Number | 1770015034
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Entity Type | Organization
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Legal Business Name | BROKEN CHAINS CHRISTIAN COUNSELING,INC.
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 8998 W RUTH AVE
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City | PEORIA
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State | AZ
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Zip | 85345-7980
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Country | US
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Telephone | 602-377-8324
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Fax |
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Provider Business Mailing Address
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Address Line | 8998 W RUTH AVE
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City | PEORIA
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State | AZ
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Zip | 85345-7980
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Country | US
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Telephone | 602-377-8324
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TRUDY MARIE SONCRANT
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Credential | MSW, LCSW, LISAC
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Telephone | 602-377-8324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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