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General NPI Number Information
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NPI Number | 1851004584
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Entity Type | Organization
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Legal Business Name | GATHERED CONNECTIONS COUNSELING PROFESSIONAL LIMITED LIABILITY COM
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 17505 N 79TH AVE STE 304C
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City | GLENDALE
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State | AZ
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Zip | 85308-8729
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Country | US
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Telephone | 623-521-5096
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Fax |
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Provider Business Mailing Address
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Address Line | 30175 W MULBERRY DR
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City | BUCKEYE
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State | AZ
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Zip | 85396-3158
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Country | US
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Telephone | 623-521-5096
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE WIEST
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Credential | LCSW
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Telephone | 623-521-5096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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