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General NPI Number Information
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NPI Number | 1902217102
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Entity Type | Organization
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Legal Business Name | WHOLEHEARTED COUNSELING PLLC
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Dates
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Enumeration Date | 05/11/2014
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Last Update Date | 05/11/2014
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Provider Practice Location Address
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Address Line | 7901 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5510
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Country | US
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Telephone | 480-751-9015
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Fax |
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Provider Business Mailing Address
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Address Line | 15608 N 71ST ST #116
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-5359
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Country | US
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Telephone | 480-751-9015
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERRY LISA FAILONI
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Credential | LPC
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Telephone | 480-751-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13401
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License Number State | AZ
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