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General NPI Number Information
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NPI Number | 1891089504
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Entity Type | Organization
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Legal Business Name | IRONWOOD COUNSELING AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 05/31/2011
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Provider Practice Location Address
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Address Line | 7400 S POWER RD
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City | GILBERT
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State | AZ
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Zip | 85297-9281
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Country | US
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Telephone | 602-573-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 E CHELSEA DR
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City | SAN TAN VALLEY
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State | AZ
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Zip | 85140-5661
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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 | OWNER
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Name | JARED DINEHART
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Credential | PH.D.
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Telephone | 602-573-5351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3930
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License Number State | AZ
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